Provider Demographics
NPI:1164720223
Name:DEEM, DANIELLE J (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:J
Last Name:DEEM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:J
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:375 ELM ST
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1107
Mailing Address - Country:US
Mailing Address - Phone:330-755-5373
Mailing Address - Fax:
Practice Address - Street 1:375 ELM ST
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1107
Practice Address - Country:US
Practice Address - Phone:330-755-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH135708164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse