Provider Demographics
NPI:1659980183
Name:DELEOM, DEANNA (LVN)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:
Last Name:DELEOM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 COLGLAZIER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-2470
Mailing Address - Country:US
Mailing Address - Phone:210-878-7482
Mailing Address - Fax:
Practice Address - Street 1:3302 COLGLAZIER AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-2470
Practice Address - Country:US
Practice Address - Phone:210-878-7482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227368164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse