Provider Demographics
NPI:1629531900
Name:DEEMER, MALAYA REYNA (CNP)
Entity Type:Individual
Prefix:
First Name:MALAYA
Middle Name:REYNA
Last Name:DEEMER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MR
Other - First Name:MALAYA
Other - Middle Name:REYNA
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:5602 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9699
Mailing Address - Country:US
Mailing Address - Phone:580-531-4786
Mailing Address - Fax:
Practice Address - Street 1:5602 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9699
Practice Address - Country:US
Practice Address - Phone:580-531-4786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK124007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily