Provider Demographics
NPI:1831634625
Name:SCALLY, DEBORAH (NP-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SCALLY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1726
Mailing Address - Country:US
Mailing Address - Phone:614-893-8122
Mailing Address - Fax:419-616-3770
Practice Address - Street 1:353 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1726
Practice Address - Country:US
Practice Address - Phone:614-893-8122
Practice Address - Fax:419-616-3770
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN293600363LF0000X
OHAPRN.CNP.020362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily