Provider Demographics
NPI:1164752705
Name:OZBOLT, DEBRA ANN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:ANN
Last Name:OZBOLT
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 1:1153 BOUGHTON ST APT 11H
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-3109
Mailing Address - Country:US
Mailing Address - Phone:920-220-9317
Mailing Address - Fax:
Practice Address - Street 1:1153 BOUGHTON ST APT 11H
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3109
Practice Address - Country:US
Practice Address - Phone:920-220-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI308281-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse