Provider Demographics
NPI:1457194631
Name:DEAN, RANDY A JR
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:A
Last Name:DEAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10755 STATE ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9697
Mailing Address - Country:US
Mailing Address - Phone:330-728-3339
Mailing Address - Fax:
Practice Address - Street 1:10755 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9697
Practice Address - Country:US
Practice Address - Phone:330-728-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker