Provider Demographics
NPI:1851671457
Name:DEHART, NEVA CARISSA (CNM)
Entity Type:Individual
Prefix:
First Name:NEVA
Middle Name:CARISSA
Last Name:DEHART
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:NEVA
Other - Middle Name:CARISSA
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:900 S DIXIE DR
Mailing Address - Street 2:SUITE 40
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2657
Mailing Address - Country:US
Mailing Address - Phone:937-890-6644
Mailing Address - Fax:937-890-1726
Practice Address - Street 1:900 S DIXIE DR
Practice Address - Street 2:SUITE 40
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2657
Practice Address - Country:US
Practice Address - Phone:937-890-6644
Practice Address - Fax:937-890-1726
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12498-NM367A00000X
OHCOA.12421-NP363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054024Medicaid
OH0054024Medicaid