Healthcare Provider Details

I. General information

NPI: 1295362663
Provider Name (Legal Business Name): DEANNA MAE LINES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4490 DARROW RD
STOW OH
44224-1885
US

IV. Provider business mailing address

1506 10TH ST
CUYAHOGA FALLS OH
44221-4630
US

V. Phone/Fax

Practice location:
  • Phone: 330-869-3900
  • Fax: 330-869-3901
Mailing address:
  • Phone: 801-856-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS023564
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: