Provider Demographics
NPI:1023186392
Name:AVERY, DEBORAH JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEAN
Last Name:AVERY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 ALTAIR DR
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1429
Mailing Address - Country:US
Mailing Address - Phone:716-636-4995
Mailing Address - Fax:
Practice Address - Street 1:175 ALTAIR DR
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1429
Practice Address - Country:US
Practice Address - Phone:716-636-4995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234748164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse