Provider Demographics
NPI:1932330313
Name:BASS, DEANNA D (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:D
Last Name:BASS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CULVER PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4550
Mailing Address - Country:US
Mailing Address - Phone:716-783-6531
Mailing Address - Fax:
Practice Address - Street 1:101 CULVER PKWY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-4550
Practice Address - Country:US
Practice Address - Phone:716-783-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296639164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse