Provider Demographics
NPI:1255320701
Name:DARNELL, DEBORAH KAY (CNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:DARNELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2663 CLEVELAND AVEUE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3393
Mailing Address - Country:US
Mailing Address - Phone:330-456-5329
Mailing Address - Fax:330-456-9679
Practice Address - Street 1:2663 CLEVELAND AVENUE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3393
Practice Address - Country:US
Practice Address - Phone:330-456-5329
Practice Address - Fax:330-456-9679
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06776363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2437563Medicaid
P53926Medicare UPIN
OHNP10044Medicare PIN