Provider Demographics
NPI:1447213426
Name:HANES, DEBORAH A (CNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:HANES
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 1:2050 KENNY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3502
Mailing Address - Country:US
Mailing Address - Phone:614-293-8054
Mailing Address - Fax:614-293-4890
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-8054
Practice Address - Fax:614-293-4890
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN234429363L00000X
OHCOA.06197.NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2467692Medicaid
OHQ00855Medicare UPIN
OH2467692Medicaid