Provider Demographics
NPI:1679816391
Name:DERMODY, EMMA M (RN)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:M
Last Name:DERMODY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4482 HYACINTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2816
Mailing Address - Country:US
Mailing Address - Phone:561-876-2879
Mailing Address - Fax:
Practice Address - Street 1:4482 HYACINTH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-2816
Practice Address - Country:US
Practice Address - Phone:561-876-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY387389-1146D00000X
CA397505251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No251E00000XAgenciesHome Health