Provider Demographics
NPI:1306257860
Name:LEDGER, DEANNA (STNA)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:LEDGER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10290 PLEASANT LAKE BLVD APT F9
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7464
Mailing Address - Country:US
Mailing Address - Phone:440-539-5729
Mailing Address - Fax:
Practice Address - Street 1:10290 PLEASANT LAKE BLVD APT F9
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-7464
Practice Address - Country:US
Practice Address - Phone:440-539-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401431670812376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0097148Medicaid