Provider Demographics
NPI:1750533980
Name:DEERING, JANNA LYNN
Entity type:Individual
Prefix:MRS
First Name:JANNA
Middle Name:LYNN
Last Name:DEERING
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 1:4590 LAKE PINE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9617
Mailing Address - Country:US
Mailing Address - Phone:231-421-3397
Mailing Address - Fax:
Practice Address - Street 1:1135 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2936
Practice Address - Country:US
Practice Address - Phone:231-929-2054
Practice Address - Fax:231-929-2084
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist