Provider Demographics
NPI:1083003784
Name:DREVON, DARCY JO (CNP)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:JO
Last Name:DREVON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:JO
Other - Last Name:VRABEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7452 FULTON DR NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9393
Mailing Address - Country:US
Mailing Address - Phone:330-833-4596
Mailing Address - Fax:330-833-1817
Practice Address - Street 1:7452 FULTON DR NW
Practice Address - Street 2:SUITE B
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9393
Practice Address - Country:US
Practice Address - Phone:330-833-4596
Practice Address - Fax:330-833-1817
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 16733-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily