Provider Demographics
NPI:1487828695
Name:BROWN-DERAMUS, JOELYNN (LPN)
Entity Type:Individual
Prefix:
First Name:JOELYNN
Middle Name:
Last Name:BROWN-DERAMUS
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 1:6456 TEAPOT LN
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3952
Mailing Address - Country:US
Mailing Address - Phone:614-986-8695
Mailing Address - Fax:
Practice Address - Street 1:6456 TEAPOT LN
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3952
Practice Address - Country:US
Practice Address - Phone:614-986-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.116364164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse