Provider Demographics
NPI:1730234329
Name:PURVIS HEATON, DEBRA ANN (RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:PURVIS HEATON
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 1:601 IVY GTWY STE 2100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-2052
Mailing Address - Country:US
Mailing Address - Phone:513-752-8000
Mailing Address - Fax:513-752-1078
Practice Address - Street 1:601 IVY GTWY STE 2100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-2052
Practice Address - Country:US
Practice Address - Phone:513-752-8000
Practice Address - Fax:513-752-1078
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN217044363L00000X
OHCOA.03080-NP363L00000X
OHAPRN.CNP.03080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP03080OtherCNP
OH0077520Medicaid
PUNP12122Medicare ID - Type Unspecified
OHNP03080OtherCNP
OHH153000Medicare PIN