Provider Demographics
NPI:1679230122
Name:COLVIN, DEBRA RAE
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:RAE
Last Name:COLVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 SILVER FOX LN NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1138
Mailing Address - Country:US
Mailing Address - Phone:330-720-7354
Mailing Address - Fax:
Practice Address - Street 1:1959 SILVER FOX LN NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1138
Practice Address - Country:US
Practice Address - Phone:234-806-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide