Provider Demographics
NPI:1881436335
Name:KLINGMAN, DEREK JAMES
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:JAMES
Last Name:KLINGMAN
Suffix:
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 1:336 VIENNA AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-2628
Mailing Address - Country:US
Mailing Address - Phone:330-770-5711
Mailing Address - Fax:
Practice Address - Street 1:336 VIENNA AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2628
Practice Address - Country:US
Practice Address - Phone:330-770-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.183188.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse