Provider Demographics
NPI:1073384269
Name:DEJESUS, DINA LUZ (CERTIFIED DOULA)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:LUZ
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PENN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON BORO
Mailing Address - State:PA
Mailing Address - Zip Code:17582-9655
Mailing Address - Country:US
Mailing Address - Phone:717-615-8448
Mailing Address - Fax:
Practice Address - Street 1:250 PENN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON BORO
Practice Address - State:PA
Practice Address - Zip Code:17582-9655
Practice Address - Country:US
Practice Address - Phone:717-615-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13737374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula