Provider Demographics
NPI:1760084800
Name:ADDISON, DEBORAH SUE
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUE
Last Name:ADDISON
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 1:10 ESTATE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1140
Mailing Address - Country:US
Mailing Address - Phone:513-628-0882
Mailing Address - Fax:
Practice Address - Street 1:10 ESTATE DR APT 2
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1140
Practice Address - Country:US
Practice Address - Phone:513-628-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide