Provider Demographics
NPI:1619560406
Name:ANSON, DEON ELIZABETH
Entity Type:Individual
Prefix:
First Name:DEON
Middle Name:ELIZABETH
Last Name:ANSON
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 1:627 E MOUNT AIRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1147
Mailing Address - Country:US
Mailing Address - Phone:267-333-0939
Mailing Address - Fax:
Practice Address - Street 1:627 E MOUNT AIRY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1147
Practice Address - Country:US
Practice Address - Phone:267-333-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN537424163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse