Healthcare Provider Details

I. General information

NPI: 1629068606
Provider Name (Legal Business Name): DEBORAH JANE NASH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S GARBER DR
TIPP CITY OH
45371-1183
US

IV. Provider business mailing address

245 S GARBER DR
TIPP CITY OH
45371-1183
US

V. Phone/Fax

Practice location:
  • Phone: 937-877-1222
  • Fax: 937-877-1222
Mailing address:
  • Phone: 937-877-1222
  • Fax: 937-877-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35044154N
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: