Provider Demographics
NPI:1700323631
Name:DERIFIELD, MIKA
Entity Type:Individual
Prefix:
First Name:MIKA
Middle Name:
Last Name:DERIFIELD
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 1:12379 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2456
Mailing Address - Country:US
Mailing Address - Phone:330-696-9066
Mailing Address - Fax:
Practice Address - Street 1:205 S PARDEE ST
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1465
Practice Address - Country:US
Practice Address - Phone:330-696-8539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility