Healthcare Provider Details

I. General information

NPI: 1689699738
Provider Name (Legal Business Name): DEBORAH MAGNOTTA C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 ACORN DR
KETTERING OH
45419-2745
US

IV. Provider business mailing address

801 WESTMINSTER PL
DAYTON OH
45419-3649
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-6500
  • Fax:
Mailing address:
  • Phone: 937-435-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP08113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: