Provider Demographics
NPI:1376959403
Name:DULANEY, JOEY
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:DULANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SHADOWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1849
Mailing Address - Country:US
Mailing Address - Phone:937-554-2433
Mailing Address - Fax:
Practice Address - Street 1:2201 SHADOWOOD CIR
Practice Address - Street 2:SUITE A
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1849
Practice Address - Country:US
Practice Address - Phone:937-554-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide