Healthcare Provider Details

I. General information

NPI: 1336442011
Provider Name (Legal Business Name): DEBRA DIANNE POGUE MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 MONTGOMERY RD SUITE 1J
CINCINNATI OH
45242-5201
US

IV. Provider business mailing address

10475 MONTGOMERY RD SUITE 1J
CINCINNATI OH
45242-5201
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-5548
  • Fax: 513-791-5549
Mailing address:
  • Phone: 513-791-5548
  • Fax: 513-791-5549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number207892
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10721
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: