=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588035604
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH LEE PISER NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2015
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 860 MAIN RD
-----------------------------------------------------
City | CORFU
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14036-9753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-321-4846
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30W MCCREIGHT AVE 209
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45504-1842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-523-9940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | COA-17957-NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------