Healthcare Provider Details

I. General information

NPI: 1366159329
Provider Name (Legal Business Name): LORIEN DEBRUYN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 W MAPLE ST STE 110
HARTVILLE OH
44632-7601
US

IV. Provider business mailing address

PO BOX 932909
CLEVELAND OH
44193-0026
US

V. Phone/Fax

Practice location:
  • Phone: 330-877-3616
  • Fax: 330-877-1783
Mailing address:
  • Phone: 330-854-4281
  • Fax: 330-854-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0032459
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: