Provider Demographics
NPI:1215733969
Name:MASTERS, DANETTE LYNN
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:LYNN
Last Name:MASTERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N SOUTH ST LOT 58
Mailing Address - Street 2:
Mailing Address - City:NEW VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45159-9203
Mailing Address - Country:US
Mailing Address - Phone:937-986-8710
Mailing Address - Fax:
Practice Address - Street 1:300 N SOUTH ST LOT 58
Practice Address - Street 2:
Practice Address - City:NEW VIENNA
Practice Address - State:OH
Practice Address - Zip Code:45159-9203
Practice Address - Country:US
Practice Address - Phone:937-986-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health