Provider Demographics
NPI:1225746290
Name:DEBASTIANI, MABEL KATHERINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MABEL
Middle Name:KATHERINE
Last Name:DEBASTIANI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ROUSCH DR
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:WV
Mailing Address - Zip Code:26501-3872
Mailing Address - Country:US
Mailing Address - Phone:304-598-6099
Mailing Address - Fax:
Practice Address - Street 1:12 ROUSCH DR
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:WV
Practice Address - Zip Code:26501-3872
Practice Address - Country:US
Practice Address - Phone:304-598-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61128163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health