Provider Demographics
NPI:1811599715
Name:BURRELL, DEBORAH ANN (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:BURRELL
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 RESERVOIR RD LOT 620
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2970
Mailing Address - Country:US
Mailing Address - Phone:567-204-6902
Mailing Address - Fax:
Practice Address - Street 1:1800 RESERVOIR RD LOT 620
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2970
Practice Address - Country:US
Practice Address - Phone:567-204-6902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker