Provider Demographics
NPI:1760527121
Name:DERDEN, KACYNTHIA (STNA)
Entity Type:Individual
Prefix:
First Name:KACYNTHIA
Middle Name:
Last Name:DERDEN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 BIGELOW ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2135
Mailing Address - Country:US
Mailing Address - Phone:419-244-3265
Mailing Address - Fax:419-244-3265
Practice Address - Street 1:2017 BIGELOW ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2135
Practice Address - Country:US
Practice Address - Phone:419-244-3265
Practice Address - Fax:419-244-3265
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH163WH0200X163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health