Provider Demographics
NPI:1659672749
Name:DJIADEU, ANIE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANIE
Middle Name:
Last Name:DJIADEU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 APEX CT.
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4012
Mailing Address - Country:US
Mailing Address - Phone:513-765-0041
Mailing Address - Fax:
Practice Address - Street 1:3 CAMELOT CIR APT E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4012
Practice Address - Country:US
Practice Address - Phone:513-330-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021260363LF0000X
OH134617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1659672749Medicaid