Provider Demographics
NPI:1720789654
Name:DEAN, DAISHA PAULETTE (RN)
Entity Type:Individual
Prefix:
First Name:DAISHA
Middle Name:PAULETTE
Last Name:DEAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 OSBORN AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1225
Mailing Address - Country:US
Mailing Address - Phone:440-412-8686
Mailing Address - Fax:
Practice Address - Street 1:1059 OSBORN AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1225
Practice Address - Country:US
Practice Address - Phone:440-412-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.510661163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse