Provider Demographics
NPI:1952161176
Name:WANG, DEBORAH KRISTINA (LPN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KRISTINA
Last Name:WANG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:KRISTINA
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4600 MONTGOMERY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2600
Mailing Address - Country:US
Mailing Address - Phone:513-374-0153
Mailing Address - Fax:866-934-7450
Practice Address - Street 1:4483 US ROUTE 42
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:866-934-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.186458164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse