Provider Demographics
NPI:1184921447
Name:TODD, DEANNA L
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:L
Last Name:TODD
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 1:4004 W CREIGHTON TER
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2912
Mailing Address - Country:US
Mailing Address - Phone:309-222-7378
Mailing Address - Fax:
Practice Address - Street 1:4004 W CREIGHTON TER
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2912
Practice Address - Country:US
Practice Address - Phone:309-222-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula