Provider Demographics
NPI:1336342401
Name:DECK-FREAS, ANNA FAYE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:FAYE
Last Name:DECK-FREAS
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 1:504 CATALINA DR
Mailing Address - Street 2:A3
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4688
Mailing Address - Country:US
Mailing Address - Phone:740-975-3057
Mailing Address - Fax:
Practice Address - Street 1:504 CATALINA DR
Practice Address - Street 2:A3
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4688
Practice Address - Country:US
Practice Address - Phone:740-975-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2092837Medicaid