Provider Demographics
NPI:1285042473
Name:STEEL, DEBRA S
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:STEEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1221
Mailing Address - Country:US
Mailing Address - Phone:937-298-4331
Mailing Address - Fax:937-522-7513
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-762-1305
Practice Address - Fax:937-522-7513
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA15389NP363LG0600X
OHAPRN.CNP.15389363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0107915Medicaid
OH0184565Medicaid
OHCOA15389NPOtherOHIO STATE LICENSE
OHH363280Medicare PIN