Provider Demographics
NPI:1477244770
Name:LARRY, DEBBIE
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:
Last Name:LARRY
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 1:162 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-1353
Mailing Address - Country:US
Mailing Address - Phone:330-423-7923
Mailing Address - Fax:
Practice Address - Street 1:162 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1353
Practice Address - Country:US
Practice Address - Phone:330-423-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide