Provider Demographics
NPI:1053882415
Name:BENDER, DEBRA ELOISE
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ELOISE
Last Name:BENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 202
Mailing Address - Street 2:6320 COUNTY ROAD 610
Mailing Address - City:SHUBUTA
Mailing Address - State:MS
Mailing Address - Zip Code:39360
Mailing Address - Country:US
Mailing Address - Phone:601-480-7276
Mailing Address - Fax:
Practice Address - Street 1:6320 COUNTY ROAD 610
Practice Address - Street 2:
Practice Address - City:SHUBUTA
Practice Address - State:MS
Practice Address - Zip Code:39360
Practice Address - Country:US
Practice Address - Phone:601-480-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)