Basic Information
| Provider Information | |||||||||
| NPI: | 1366159329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEBRUYN | ||||||||
| FirstName: | LORIEN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 932909 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308544281 | ||||||||
| FaxNumber: | 3308540032 | ||||||||
| Practice Location | |||||||||
| Address1: | 855 W MAPLE ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | HARTVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446327601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308773616 | ||||||||
| FaxNumber: | 3308771783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2022 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.0032459 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.