Provider Demographics
NPI:1134721376
Name:DEGEO, MARIKA
Entity type:Individual
Prefix:MRS
First Name:MARIKA
Middle Name:
Last Name:DEGEO
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 1:165 VILLAGE GATE BLVD APT 115
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8543
Mailing Address - Country:US
Mailing Address - Phone:614-500-9115
Mailing Address - Fax:
Practice Address - Street 1:165 VILLAGE GATE BLVD APT 115
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8543
Practice Address - Country:US
Practice Address - Phone:614-463-0770
Practice Address - Fax:740-927-2807
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2538516OtherDODD
OH2538516Medicaid
OH2720783Medicaid