Healthcare Provider Details

I. General information

NPI: 1508290826
Provider Name (Legal Business Name): YOLANDA VENA DELEON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 CARROLL AVE
DAYTON OH
45405-2304
US

IV. Provider business mailing address

3819 CARROLL AVE
DAYTON OH
45405-2304
US

V. Phone/Fax

Practice location:
  • Phone: 937-221-8008
  • Fax:
Mailing address:
  • Phone: 937-221-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN300210
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN300210
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN300210
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: