Provider Demographics
NPI:1003403213
Name:DETMAYER, DEBORAH DALINE
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DALINE
Last Name:DETMAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 N JEFFERSON ST UNIT 53
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-6638
Mailing Address - Country:US
Mailing Address - Phone:216-408-0977
Mailing Address - Fax:
Practice Address - Street 1:1151 N JEFFERSON ST UNIT 53
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-6638
Practice Address - Country:US
Practice Address - Phone:216-408-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant