Provider Demographics
NPI:1093582926
Name:MCMULLIN, DEZARAY CHRISTIAN (RN)
Entity Type:Individual
Prefix:
First Name:DEZARAY
Middle Name:CHRISTIAN
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6834 W SHERRI DR
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2440
Mailing Address - Country:US
Mailing Address - Phone:216-526-7290
Mailing Address - Fax:
Practice Address - Street 1:6834 W SHERRI DR
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2440
Practice Address - Country:US
Practice Address - Phone:216-526-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.445771163WC0400X, 163WC1600X, 163WC2100X, 163WG0000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice