Provider Demographics
NPI:1649994856
Name:TRUETT, DARNELL L SR
Entity type:Individual
Prefix:
First Name:DARNELL
Middle Name:L
Last Name:TRUETT
Suffix:SR
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 1:29481 EDDY RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1441
Mailing Address - Country:US
Mailing Address - Phone:216-409-6031
Mailing Address - Fax:
Practice Address - Street 1:29481 EDDY RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44092-1441
Practice Address - Country:US
Practice Address - Phone:216-409-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.003286175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist