Provider Demographics
NPI:1205036605
Name:DEGRADO, DEIDRE D (CPM)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:D
Last Name:DEGRADO
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S STAGECOACH CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-9136
Mailing Address - Country:US
Mailing Address - Phone:316-371-0707
Mailing Address - Fax:
Practice Address - Street 1:910 S STAGECOACH CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67230-9136
Practice Address - Country:US
Practice Address - Phone:316-371-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12080014176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife