Provider Demographics
NPI:1104420082
Name:FLUGGA, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:FLUGGA
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 1:2110 SCHEID RD
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-9385
Mailing Address - Country:US
Mailing Address - Phone:419-433-0355
Mailing Address - Fax:
Practice Address - Street 1:2110 SCHEID RD
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-9385
Practice Address - Country:US
Practice Address - Phone:419-433-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2889487Medicaid