Healthcare Provider Details

I. General information

NPI: 1639595671
Provider Name (Legal Business Name): DEANNA L ROCKWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7941 BRUSH LAKE RD
NORTH LEWISBURG OH
43060-9617
US

IV. Provider business mailing address

6308 MILLERSTOWN ERIS RD.
URBANA OH
43078
US

V. Phone/Fax

Practice location:
  • Phone: 937-826-3771
  • Fax:
Mailing address:
  • Phone: 937-663-4787
  • Fax: 937-484-1571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number210871
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: