Provider Demographics
NPI:1669684320
Name:GRESHAM, DEBORAH D (CNS, RNC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:D
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:CNS, RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 VINTAGE LAKE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4088
Mailing Address - Country:US
Mailing Address - Phone:937-885-3401
Mailing Address - Fax:
Practice Address - Street 1:870 VINTAGE LAKE CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-4088
Practice Address - Country:US
Practice Address - Phone:937-885-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136463163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk