Provider Demographics
NPI:1649572918
Name:STORMS, DEBRA (LPN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:STORMS
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 1:100 TAYLOR DR APT 5
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1255
Mailing Address - Country:US
Mailing Address - Phone:937-403-6492
Mailing Address - Fax:
Practice Address - Street 1:100 TAYLOR DR APT 5
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1255
Practice Address - Country:US
Practice Address - Phone:937-403-6492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.118756-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse