Provider Demographics
NPI:1669536751
Name:ELDRIDGE, DEBRA LEE
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEE
Last Name:ELDRIDGE
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 1:207 STONEMONT CT
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1135
Mailing Address - Country:US
Mailing Address - Phone:937-698-6217
Mailing Address - Fax:937-698-1016
Practice Address - Street 1:207 STONEMONT CT
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-1135
Practice Address - Country:US
Practice Address - Phone:937-698-6217
Practice Address - Fax:937-698-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2593037Medicaid