Provider Demographics
NPI:1356814669
Name:ITSKIN, DEBRA JO (LPN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JO
Last Name:ITSKIN
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 1:42 EAST CRESCENTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1302
Mailing Address - Country:US
Mailing Address - Phone:513-671-7117
Mailing Address - Fax:513-671-7110
Practice Address - Street 1:42 EAST CRESCENTVILLE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1302
Practice Address - Country:US
Practice Address - Phone:513-671-7117
Practice Address - Fax:513-671-7110
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH069444164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse