Provider Demographics
NPI:1063994051
Name:THOMAS, DEANNA
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:HANYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:GLEN AUBREY
Mailing Address - State:NY
Mailing Address - Zip Code:13777-0009
Mailing Address - Country:US
Mailing Address - Phone:607-242-8830
Mailing Address - Fax:
Practice Address - Street 1:24 LEEKVILLE RD LOT 1
Practice Address - Street 2:
Practice Address - City:GLEN AUBREY
Practice Address - State:NY
Practice Address - Zip Code:13777-1102
Practice Address - Country:US
Practice Address - Phone:607-242-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X, 372600000X
NY372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion