Provider Demographics
NPI:1699486571
Name:WITHROW, DEANA DANIELLE
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:DANIELLE
Last Name:WITHROW
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 1:161 HOLSCLAW DR
Mailing Address - Street 2:
Mailing Address - City:ELKVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25071-6365
Mailing Address - Country:US
Mailing Address - Phone:304-741-9433
Mailing Address - Fax:
Practice Address - Street 1:161 HOLSCLAW DR
Practice Address - Street 2:
Practice Address - City:ELKVIEW
Practice Address - State:WV
Practice Address - Zip Code:25071-6365
Practice Address - Country:US
Practice Address - Phone:304-741-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant