Healthcare Provider Details

I. General information

NPI: 1588035604
Provider Name (Legal Business Name): DEBORAH LEE PISER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MAIN RD
CORFU NY
14036-9753
US

IV. Provider business mailing address

30W MCCREIGHT AVE 209
SPRINGFIELD OH
45504-1842
US

V. Phone/Fax

Practice location:
  • Phone: 937-321-4846
  • Fax:
Mailing address:
  • Phone: 937-523-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA-17957-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: