Provider Demographics
NPI:1023554490
Name:DEAN, JOLYN
Entity Type:Individual
Prefix:
First Name:JOLYN
Middle Name:
Last Name:DEAN
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 1:3 EDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:OH
Mailing Address - Zip Code:43844
Mailing Address - Country:US
Mailing Address - Phone:740-502-4498
Mailing Address - Fax:
Practice Address - Street 1:3 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:OH
Practice Address - Zip Code:43844-9018
Practice Address - Country:US
Practice Address - Phone:740-502-4498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2791831Medicaid