Provider Demographics
NPI:1063904514
Name:BELLVILLE, DEANNA MARIE (PPCNP-BC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:BELLVILLE
Suffix:
Gender:F
Credentials:PPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 MARKET ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3457
Mailing Address - Country:US
Mailing Address - Phone:330-746-8040
Mailing Address - Fax:
Practice Address - Street 1:6505 MARKET ST BLDG A1
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-746-8040
Practice Address - Fax:330-746-8025
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022671208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics