Provider Demographics
NPI:1295340065
Name:VON ENCK, DEBRA ZOOK
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ZOOK
Last Name:VON ENCK
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 1:6707 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4595
Mailing Address - Country:US
Mailing Address - Phone:440-888-7722
Mailing Address - Fax:440-866-6040
Practice Address - Street 1:6707 STATE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-4595
Practice Address - Country:US
Practice Address - Phone:440-545-7037
Practice Address - Fax:440-866-6040
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNS00461364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical