Provider Demographics
NPI:1598453169
Name:DERUY, PAULA M
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:DERUY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10495 WELLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7683
Mailing Address - Country:US
Mailing Address - Phone:614-507-0534
Mailing Address - Fax:
Practice Address - Street 1:10495 WELLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7683
Practice Address - Country:US
Practice Address - Phone:614-507-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care