Provider Demographics
NPI:1730678053
Name:ULTSCH, DEBBIE JEAN (CNO)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:JEAN
Last Name:ULTSCH
Suffix:
Gender:F
Credentials:CNO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 TRACY RD
Mailing Address - Street 2:
Mailing Address - City:FORESTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13338-2024
Mailing Address - Country:US
Mailing Address - Phone:315-796-3722
Mailing Address - Fax:
Practice Address - Street 1:1400 NOYES ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3854
Practice Address - Country:US
Practice Address - Phone:315-738-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY437185163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator