Provider Demographics
NPI:1154645380
Name:CRUEA, DEAN'NA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:DEAN'NA
Middle Name:LYNN
Last Name:CRUEA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 N. HIGH STREET SUITE A
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133
Mailing Address - Country:US
Mailing Address - Phone:937-393-0988
Mailing Address - Fax:937-393-0988
Practice Address - Street 1:902 N HIGH ST APT A
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1576
Practice Address - Country:US
Practice Address - Phone:937-393-0988
Practice Address - Fax:937-393-0988
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017751171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor