MEDICARE: LORIEN DEBRUYN NP

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
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0032459	OH

General Provider Information

NPI Number	:	1366159329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIEN DEBRUYN NP

Provider Business Mailing Address
First Line	:	PO BOX 932909
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0026
Country	:	US
Telephone Number	:	330-854-4281
Fax Number	:	330-854-0032

Provider Business Practice Location Address
First Line	:	855 W MAPLE ST STE 110
Second Line	:
City	:	HARTVILLE
State	:	OH
Zip	:	44632-7601
Country	:	US
Telephone Number	:	330-877-3616
Fax Number	:	330-877-1783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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