Provider Demographics
NPI:1609281740
Name:LAYTON, DOREEN P
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:P
Last Name:LAYTON
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 1:212 HIGHLAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-3601
Mailing Address - Country:US
Mailing Address - Phone:330-770-1154
Mailing Address - Fax:
Practice Address - Street 1:212 HIGHLAND AVE SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-3601
Practice Address - Country:US
Practice Address - Phone:330-770-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3124578Medicaid