MEDICARE: DEBRA RAE COLVIN

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1679230122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA RAE COLVIN

Provider Business Mailing Address
First Line	:	1959 SILVER FOX LN NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-1138
Country	:	US
Telephone Number	:	330-720-7354
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 SILVER FOX LN NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-1138
Country	:	US
Telephone Number	:	234-806-4135
Fax Number	:

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

Provider Enumeration Date	:	11/19/2021
Last Update Date	:	11/19/2021

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Directions to “ DEBRA RAE COLVIN ” Practice Location

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