Provider Demographics
NPI:1003980707
Name:FELL, DEBORAH JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JO
Last Name:FELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7097 ONTARIO CENTER RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9566
Mailing Address - Country:US
Mailing Address - Phone:315-524-6694
Mailing Address - Fax:315-524-6694
Practice Address - Street 1:7097 ONTARIO CENTER RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-9566
Practice Address - Country:US
Practice Address - Phone:315-524-6694
Practice Address - Fax:315-524-6694
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221673164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01654535Medicaid