Provider Demographics
NPI:1356318646
Name:LANDAKER, DEBORAH MARLENE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MARLENE
Last Name:LANDAKER
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 1:310 CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:STOCKPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43787-8592
Mailing Address - Country:US
Mailing Address - Phone:740-551-9309
Mailing Address - Fax:
Practice Address - Street 1:310 CUSTER RD
Practice Address - Street 2:
Practice Address - City:STOCKPORT
Practice Address - State:OH
Practice Address - Zip Code:43787-8592
Practice Address - Country:US
Practice Address - Phone:740-551-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-05
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN089152164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2231481Medicaid