Provider Demographics
NPI:1770160939
Name:DEETER, DANETTE LOUISE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:LOUISE
Last Name:DEETER
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 1:4347 LISBON RD
Mailing Address - Street 2:
Mailing Address - City:LEETONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44431-9711
Mailing Address - Country:US
Mailing Address - Phone:330-257-9931
Mailing Address - Fax:
Practice Address - Street 1:4347 LISBON RD
Practice Address - Street 2:
Practice Address - City:LEETONIA
Practice Address - State:OH
Practice Address - Zip Code:44431-9711
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH132239164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse