Provider Demographics
NPI:1619274115
Name:FERRELL, DE ANN L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DE ANN
Middle Name:L
Last Name:FERRELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 W PECOS RD
Mailing Address - Street 2:#2134
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5212
Mailing Address - Country:US
Mailing Address - Phone:480-374-0888
Mailing Address - Fax:
Practice Address - Street 1:1175 W PECOS RD
Practice Address - Street 2:#2134
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5212
Practice Address - Country:US
Practice Address - Phone:480-374-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-14733173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist