Provider Demographics
NPI:1518425099
Name:DEAN, JOSIE J (NP)
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:J
Last Name:DEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:JEAN
Other - Last Name:LEATHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HEALTH OFFICER
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1720 BEACON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4749
Practice Address - Country:US
Practice Address - Phone:260-373-8000
Practice Address - Fax:260-373-8034
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.229957163WP0807X
IN71009903A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.227957OtherOHIO BOARD OF NURSING