Provider Demographics
NPI:1912035718
Name:MAY, DELORIS JANE (NURSING AIDE)
Entity Type:Individual
Prefix:MRS
First Name:DELORIS
Middle Name:JANE
Last Name:MAY
Suffix:
Gender:F
Credentials:NURSING AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6177 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-3109
Mailing Address - Country:US
Mailing Address - Phone:440-257-2674
Mailing Address - Fax:
Practice Address - Street 1:6177 LAKE RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-3109
Practice Address - Country:US
Practice Address - Phone:440-257-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400222360303376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2385931Medicaid