Provider Demographics
NPI:1649336868
Name:DEITZ, EVE E (LPN)
Entity type:Individual
Prefix:MRS
First Name:EVE
Middle Name:E
Last Name:DEITZ
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 1:330 S REGENT ST
Mailing Address - Street 2:APT #3F
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4739
Mailing Address - Country:US
Mailing Address - Phone:914-937-0432
Mailing Address - Fax:
Practice Address - Street 1:1630 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3125
Practice Address - Country:US
Practice Address - Phone:914-698-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252113164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01959833Medicare UPIN