Provider Demographics
NPI:1629313648
Name:JOSEPH, DEBORA LOU (LPN)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:LOU
Last Name:JOSEPH
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 1:6163 BELLVERNON DR
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MI
Mailing Address - Zip Code:49266-9713
Mailing Address - Country:US
Mailing Address - Phone:517-797-5482
Mailing Address - Fax:517-797-5482
Practice Address - Street 1:6163 BELLVERNON DR
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MI
Practice Address - Zip Code:49266-9713
Practice Address - Country:US
Practice Address - Phone:517-797-5482
Practice Address - Fax:517-797-5482
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.143193-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse