Provider Demographics
NPI:1528385622
Name:MIHALIK, DEBRA KAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:KAY
Last Name:MIHALIK
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 1:515 FAIRVIEW ST
Mailing Address - Street 2:P.O. BOX 799
Mailing Address - City:AVIS
Mailing Address - State:PA
Mailing Address - Zip Code:17721-9073
Mailing Address - Country:US
Mailing Address - Phone:570-419-0391
Mailing Address - Fax:
Practice Address - Street 1:515 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:AVIS
Practice Address - State:PA
Practice Address - Zip Code:17721-9073
Practice Address - Country:US
Practice Address - Phone:570-419-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN259436L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse