Provider Demographics
NPI:1780273391
Name:YACOVONE, DEBRA A
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:A
Last Name:YACOVONE
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 1:8338 GREYHAWK CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2001
Mailing Address - Country:US
Mailing Address - Phone:740-602-0491
Mailing Address - Fax:
Practice Address - Street 1:8338 GREYHAWK CIR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2001
Practice Address - Country:US
Practice Address - Phone:740-602-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2106518OtherDCBDD