Provider Demographics
NPI:1205534526
Name:LORE, DEANA
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:LORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:739 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1361
Mailing Address - Country:US
Mailing Address - Phone:740-412-1504
Mailing Address - Fax:
Practice Address - Street 1:739 SHERMAN RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1361
Practice Address - Country:US
Practice Address - Phone:740-412-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH71030593747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0458938Medicaid