Provider Demographics
NPI:1710006978
Name:BLANK, DELERISA JANET (HOME HEALTH CARE)
Entity Type:Individual
Prefix:MRS
First Name:DELERISA
Middle Name:JANET
Last Name:BLANK
Suffix:
Gender:F
Credentials:HOME HEALTH CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16507 CLEMENTS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-9765
Mailing Address - Country:US
Mailing Address - Phone:937-444-3596
Mailing Address - Fax:937-444-3596
Practice Address - Street 1:16507 CLEMENTS RD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-9765
Practice Address - Country:US
Practice Address - Phone:937-444-3596
Practice Address - Fax:937-444-3596
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide