Provider Demographics
NPI:1285747972
Name:DEHELIAN, LAURA MARIE (PHD, APRN,BC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:DEHELIAN
Suffix:
Gender:F
Credentials:PHD, APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24800 HIGHPOINT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6041
Mailing Address - Country:US
Mailing Address - Phone:216-831-6611
Mailing Address - Fax:216-831-2726
Practice Address - Street 1:24800 HIGHPOINT RD
Practice Address - Street 2:SUITE B
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6041
Practice Address - Country:US
Practice Address - Phone:216-831-6611
Practice Address - Fax:216-831-2726
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN121343 NS01407363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNS00895Medicare ID - Type Unspecified
OHNS00891Medicare ID - Type Unspecified
OHS60175Medicare UPIN
OHNS00892Medicare ID - Type Unspecified
OHNS00894Medicare ID - Type Unspecified