MEDICARE: MRS. DEBORAH M. WIATER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	OH 50-00-0724	OH

General Provider Information

NPI Number	:	1346327582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH M. WIATER PA-C

Provider Business Mailing Address
First Line	:	12049 WESKEN LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-1720
Country	:	US
Telephone Number	:	513-489-6490
Fax Number	:

Provider Business Practice Location Address
First Line	:	12049 WESKEN LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-1720
Country	:	US
Telephone Number	:	513-489-6490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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