Provider Demographics
NPI:1306038815
Name:DERRY, DEANNE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:MARIE
Last Name:DERRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2414
Mailing Address - Country:US
Mailing Address - Phone:330-606-5653
Mailing Address - Fax:
Practice Address - Street 1:3452 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2414
Practice Address - Country:US
Practice Address - Phone:330-606-5653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 100639164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse