Provider Demographics
NPI:1417712282
Name:LAYNE, DENVER JACOB ARLIN
Entity Type:Individual
Prefix:
First Name:DENVER
Middle Name:JACOB ARLIN
Last Name:LAYNE
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 1:101 N MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-1147
Mailing Address - Country:US
Mailing Address - Phone:740-418-8652
Mailing Address - Fax:
Practice Address - Street 1:21 NORTH MINNESTOA AVE
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692
Practice Address - Country:US
Practice Address - Phone:740-418-8652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant