Provider Demographics
NPI:1215556196
Name:DEBARDELABEN, THOMAS AARON JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:AARON
Last Name:DEBARDELABEN
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 HELMSDALE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2301
Mailing Address - Country:US
Mailing Address - Phone:216-326-7884
Mailing Address - Fax:
Practice Address - Street 1:865 HELMSDALE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44112-2301
Practice Address - Country:US
Practice Address - Phone:216-326-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.174595164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse