Provider Demographics
NPI:1316391832
Name:GUY, DEANA (LPN)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:GUY
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 1:415 CASS ST
Mailing Address - Street 2:SUITE 2A & 2D
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2589
Mailing Address - Country:US
Mailing Address - Phone:231-922-4810
Mailing Address - Fax:231-943-2590
Practice Address - Street 1:940 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2893
Practice Address - Country:US
Practice Address - Phone:231-922-4810
Practice Address - Fax:231-929-0416
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703103583164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1184087272Medicaid
MI1629431713Medicaid