MEDICARE: DEREKIA MAHONE

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	163WH0200X	Home Health Registered Nurse	401114940710	OH

General Provider Information

NPI Number	:	1780041764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREKIA MAHONE

Provider Business Mailing Address
First Line	:	931 F ST
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44052-2121
Country	:	US
Telephone Number	:	440-506-4233
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 S DANLEY SQ
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44052-2259
Country	:	US
Telephone Number	:	440-506-4233
Fax Number	:

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

Provider Enumeration Date	:	01/22/2016
Last Update Date	:	08/10/2016

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Directions to “ DEREKIA MAHONE ” Practice Location

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