Provider Demographics
NPI:1053954396
Name:WOLFORD, DEBORAH JEAN (RN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3049
Mailing Address - Country:US
Mailing Address - Phone:440-258-3888
Mailing Address - Fax:
Practice Address - Street 1:174 MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2786
Practice Address - Country:US
Practice Address - Phone:440-723-8995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.144230163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)