MEDICARE: MR. DEBORAH MAGNOTTA C.N.P.

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	363LW0102X	Women's Health Nurse Practitioner	NP08113	OH

General Provider Information

NPI Number	:	1689699738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEBORAH MAGNOTTA C.N.P.

Provider Business Mailing Address
First Line	:	801 WESTMINSTER PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-3649
Country	:	US
Telephone Number	:	937-435-9651
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 ACORN DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45419-2745
Country	:	US
Telephone Number	:	937-435-6500
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/24/2012

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