Healthcare Provider Details

I. General information

NPI: 1912035718
Provider Name (Legal Business Name): DELORIS JANE MAY NURSING AIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6177 LAKE RD
MENTOR OH
44060-3109
US

IV. Provider business mailing address

6177 LAKE RD
MENTOR OH
44060-3109
US

V. Phone/Fax

Practice location:
  • Phone: 440-257-2674
  • Fax:
Mailing address:
  • Phone: 440-257-2674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400222360303
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: