Provider Demographics
NPI:1164979134
Name:DEABAY, JODI (LPN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:DEABAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:CORNEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1320 OXBOW RD
Mailing Address - Street 2:
Mailing Address - City:OXBOW
Mailing Address - State:ME
Mailing Address - Zip Code:04764-3112
Mailing Address - Country:US
Mailing Address - Phone:207-538-7587
Mailing Address - Fax:
Practice Address - Street 1:30 HOULTON ST
Practice Address - Street 2:
Practice Address - City:PATTEN
Practice Address - State:ME
Practice Address - Zip Code:04765
Practice Address - Country:US
Practice Address - Phone:207-538-7587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELPN11334164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse