Provider Demographics
NPI:1689699738
Name:MAGNOTTA, DEBORAH (CNP)
Entity Type:Individual
Prefix:MR
First Name:DEBORAH
Middle Name:
Last Name:MAGNOTTA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3649
Mailing Address - Country:US
Mailing Address - Phone:937-435-9651
Mailing Address - Fax:
Practice Address - Street 1:2221 ACORN DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45419-2745
Practice Address - Country:US
Practice Address - Phone:937-435-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08113363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH260277Medicare ID - Type Unspecified