Healthcare Provider Details

I. General information

NPI: 1669780243
Provider Name (Legal Business Name): CHERYL JANE DEMAS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2889 RICE RD
ROCK CREEK OH
44084-9643
US

IV. Provider business mailing address

2889 RICE RD
ROCK CREEK OH
44084-9643
US

V. Phone/Fax

Practice location:
  • Phone: 440-563-5610
  • Fax:
Mailing address:
  • Phone: 440-563-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number119870
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: