Provider Demographics
NPI:1962548545
Name:MEUCHE, DEBRA KIM (CNM)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:KIM
Last Name:MEUCHE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 WALNUT GROVE LN
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8289
Mailing Address - Country:US
Mailing Address - Phone:330-297-6054
Mailing Address - Fax:
Practice Address - Street 1:6847 N CHESTNUT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3929
Practice Address - Country:US
Practice Address - Phone:330-296-4165
Practice Address - Fax:330-296-5536
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-185626163W00000X
OHCNM-03539367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2053674Medicaid
OH2053674Medicaid
OHMENM75491Medicare ID - Type Unspecified