Basic Information
| Provider Information | |||||||||
| NPI: | 1922060532 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIKE | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 558 TALLOW TREE WAY | ||||||||
| Address2: | |||||||||
| City: | TIPP CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453712746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376675474 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3333 BURNET AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136364200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 07/31/2015 | ||||||||
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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 | 363LN0000X | NP-01541 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
ID Information
| ID | Type | State | Issuer | Description | 2220484 | 05 | OH | MEDICAID |