Provider Demographics
NPI:1396811949
Name:IZZIO, DEBRA ANN (RPA C)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:IZZIO
Suffix:
Gender:F
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CENTER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1769
Mailing Address - Country:US
Mailing Address - Phone:716-672-5420
Mailing Address - Fax:716-672-6368
Practice Address - Street 1:529 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2514
Practice Address - Country:US
Practice Address - Phone:716-672-5420
Practice Address - Fax:716-672-6368
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02901586Medicaid
NY02901586Medicaid