Provider Demographics
NPI:1316647191
Name:YOUNG, DEANNA MICHELE
Entity type:Individual
Prefix:MISS
First Name:DEANNA
Middle Name:MICHELE
Last Name:YOUNG
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 1:3461 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:MC CLURE
Mailing Address - State:OH
Mailing Address - Zip Code:43534-9748
Mailing Address - Country:US
Mailing Address - Phone:419-438-0086
Mailing Address - Fax:
Practice Address - Street 1:3461 COUNTY RD N
Practice Address - Street 2:
Practice Address - City:MC CLURE
Practice Address - State:OH
Practice Address - Zip Code:43534-9748
Practice Address - Country:US
Practice Address - Phone:419-438-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X, 3747P1801X, 376J00000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker