Provider Demographics
NPI:1821188798
Name:ARDIZZONE, DEBRA LYN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYN
Last Name:ARDIZZONE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:LYN
Other - Last Name:TAVELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 COLERIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3111
Mailing Address - Country:US
Mailing Address - Phone:814-944-5588
Mailing Address - Fax:
Practice Address - Street 1:1402 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2415
Practice Address - Country:US
Practice Address - Phone:814-940-2000
Practice Address - Fax:814-569-1878
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN258542L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse