Provider Demographics
NPI:1265796338
Name:PERDUE, DEBORAH ADORA GAIL (LPN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ADORA GAIL
Last Name:PERDUE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6876 MANOR CREST LN
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7806
Mailing Address - Country:US
Mailing Address - Phone:614-940-8222
Mailing Address - Fax:
Practice Address - Street 1:6876 MANOR CREST LN
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7806
Practice Address - Country:US
Practice Address - Phone:614-940-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.135528-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse