Healthcare Provider Details

I. General information

NPI: 1700877727
Provider Name (Legal Business Name): DEBORAH DOWNES
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WPAFB OH
45433-5546
US

IV. Provider business mailing address

219 W XENIA DR
FAIRBORN OH
45324-4920
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-9069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: