Provider Demographics
NPI:1528293859
Name:REDMON, D'JUANA RENEE' (CCP)
Entity type:Individual
Prefix:MRS
First Name:D'JUANA
Middle Name:RENEE'
Last Name:REDMON
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 CONSERVATION CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4385
Mailing Address - Country:US
Mailing Address - Phone:937-879-5500
Mailing Address - Fax:
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:SUITE 555
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1840
Practice Address - Country:US
Practice Address - Phone:937-275-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist