Provider Demographics
NPI:1164062337
Name:HOSHNIC, DEIRDRE VALERIE
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:VALERIE
Last Name:HOSHNIC
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 1:13229 S 48TH ST APT A1047
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5145
Mailing Address - Country:US
Mailing Address - Phone:480-586-8726
Mailing Address - Fax:
Practice Address - Street 1:13229 S 48TH ST APT A1047
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5145
Practice Address - Country:US
Practice Address - Phone:480-586-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health