Provider Demographics
NPI:1548876873
Name:LOCOCO, DEANNA LYNN
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:LOCOCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24269 FAIRLAWN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1514
Mailing Address - Country:US
Mailing Address - Phone:440-724-6517
Mailing Address - Fax:
Practice Address - Street 1:24269 FAIRLAWN DR
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-1514
Practice Address - Country:US
Practice Address - Phone:440-724-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3055189Medicaid