Provider Demographics
NPI:1780156679
Name:GILMORE, DEBRA SUE
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:GILMORE
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 1:7776 TOWNSHIP ROAD 30
Mailing Address - Street 2:
Mailing Address - City:DE GRAFF
Mailing Address - State:OH
Mailing Address - Zip Code:43318-9633
Mailing Address - Country:US
Mailing Address - Phone:937-407-9036
Mailing Address - Fax:
Practice Address - Street 1:7776 TOWNSHIP ROAD 30
Practice Address - Street 2:
Practice Address - City:DE GRAFF
Practice Address - State:OH
Practice Address - Zip Code:43318-9633
Practice Address - Country:US
Practice Address - Phone:937-407-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.227947163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health