Provider Demographics
NPI:1285939207
Name:JAGIEL, DEBRA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:JAGIEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 BEECH DR
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-9655
Mailing Address - Country:US
Mailing Address - Phone:440-821-5502
Mailing Address - Fax:
Practice Address - Street 1:4115 BEECH DR
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287-9655
Practice Address - Country:US
Practice Address - Phone:440-821-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN139588-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse