Healthcare Provider Details

I. General information

NPI: 1134422645
Provider Name (Legal Business Name): DEANNA BERRY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEANNA WESTFALL

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 E MARKET ST
WARREN OH
44483-6644
US

IV. Provider business mailing address

1350 E MARKET ST
WARREN OH
44483-6608
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 330-757-0000
Mailing address:
  • Phone: 330-841-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN274661
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.18911
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: