MEDICARE: STACI-LOVE DEVEREAUX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1114633005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACI-LOVE DEVEREAUX

Provider Business Mailing Address
First Line	:	2140 8TH ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44704-2218
Country	:	US
Telephone Number	:	330-481-3650
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 8TH ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44704-2218
Country	:	US
Telephone Number	:	330-481-3650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	02/27/2023

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Directions to “ STACI-LOVE DEVEREAUX ” Practice Location

Language	Start Address	Practice Location

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