Provider Demographics
NPI:1629283387
Name:DURHAM, DEBORAH KAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KAY
Last Name:DURHAM
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 1:3616 WAYNESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:OH
Mailing Address - Zip Code:45370-9727
Mailing Address - Country:US
Mailing Address - Phone:937-848-3230
Mailing Address - Fax:
Practice Address - Street 1:3616 WAYNESVILLE RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:OH
Practice Address - Zip Code:45370-9727
Practice Address - Country:US
Practice Address - Phone:937-848-3230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 100735164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse