Healthcare Provider Details

I. General information

NPI: 1831634625
Provider Name (Legal Business Name): DEBORAH SCALLY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 ONTARIO ST
HURON OH
44839-1726
US

IV. Provider business mailing address

353 ONTARIO ST
HURON OH
44839-1726
US

V. Phone/Fax

Practice location:
  • Phone: 614-893-8122
  • Fax: 419-616-3770
Mailing address:
  • Phone: 614-893-8122
  • Fax: 419-616-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN293600
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020362
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: