Provider Demographics
NPI:1558626135
Name:DEREUS, PIPER LYNN (RN)
Entity type:Individual
Prefix:
First Name:PIPER
Middle Name:LYNN
Last Name:DEREUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PIPER
Other - Middle Name:LYNN
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:249 S 700 E APT 57
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2145
Mailing Address - Country:US
Mailing Address - Phone:801-907-0317
Mailing Address - Fax:
Practice Address - Street 1:249 S 700 E APT 57
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2145
Practice Address - Country:US
Practice Address - Phone:801-907-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50704753102163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health