Provider Demographics
NPI:1154851947
Name:ROSS, DEBORAH LOUISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LOUISE
Last Name:ROSS
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 1:6460 WOLF CREEK PIKE
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2932
Mailing Address - Country:US
Mailing Address - Phone:937-371-3610
Mailing Address - Fax:
Practice Address - Street 1:6460 WOLF CREEK PIKE
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2932
Practice Address - Country:US
Practice Address - Phone:937-371-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159015164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH164W00000XMedicaid