Provider Demographics
NPI:1568129062
Name:GISSENDANNER, DEADDRA DEION
Entity Type:Individual
Prefix:MS
First Name:DEADDRA
Middle Name:DEION
Last Name:GISSENDANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEADDRA
Other - Middle Name:
Other - Last Name:GISSENDANNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7012 50TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-7358
Mailing Address - Country:US
Mailing Address - Phone:404-974-8915
Mailing Address - Fax:
Practice Address - Street 1:7012 50TH AVE E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-7358
Practice Address - Country:US
Practice Address - Phone:404-974-8915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula