Basic Information
| Provider Information | |||||||||
| NPI: | 1609057124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29160 CENTER RIDGE RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WESTLAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406171823 | ||||||||
| FaxNumber: | 4406170884 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE EAGLE VALLEY COURT | ||||||||
| Address2: | |||||||||
| City: | BROADVIEW HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407461055 | ||||||||
| FaxNumber: | 4407461052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 01/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50002610 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.