MEDICARE: DEAUNA TODD B.S.N, RN

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	163W00000X	Registered Nurse	358438	OH

General Provider Information

NPI Number	:	1235415282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAUNA TODD B.S.N, RN

Provider Business Mailing Address
First Line	:	13855 SUPERIOR RD
Second Line	:	APT 2403
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44118-1079
Country	:	US
Telephone Number	:	216-965-2769
Fax Number	:

Provider Business Practice Location Address
First Line	:	13855 SUPERIOR RD
Second Line	:	APT 2403
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44118-1079
Country	:	US
Telephone Number	:	216-965-2769
Fax Number	:

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

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	10/21/2011

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