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NPI Code Detail

MEDICARE: DEBRA JO ITSKIN LPN

MEDICARE: DEBRA JO ITSKIN LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse069444OH

General Provider Information

NPI Number : 1356814669
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA JO ITSKIN LPN
Provider Business Mailing Address
First Line : 42 EAST CRESCENTVILLE RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-1302
Country : US
Telephone Number : 513-671-7117
Fax Number : 513-671-7110
Provider Business Practice Location Address
First Line : 42 EAST CRESCENTVILLE RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-1302
Country : US
Telephone Number : 513-671-7117
Fax Number : 513-671-7110
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2019
Last Update Date : 01/09/2019

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