Provider Demographics
NPI:1780041764
Name:MAHONE, DEREKIA
Entity Type:Individual
Prefix:
First Name:DEREKIA
Middle Name:
Last Name:MAHONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 F ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-2121
Mailing Address - Country:US
Mailing Address - Phone:440-506-4233
Mailing Address - Fax:
Practice Address - Street 1:1310 S DANLEY SQ
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-2259
Practice Address - Country:US
Practice Address - Phone:440-506-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401114940710163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health