Provider Demographics
NPI:1548911191
Name:DEYO, LAURA B
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:DEYO
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 1:1008 PEACH GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ST STEPHENS, CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:23148
Mailing Address - Country:US
Mailing Address - Phone:804-296-7234
Mailing Address - Fax:
Practice Address - Street 1:1008 PEACH GROVE RD
Practice Address - Street 2:
Practice Address - City:ST STEPHENS, CHURCH
Practice Address - State:VA
Practice Address - Zip Code:23148
Practice Address - Country:US
Practice Address - Phone:804-296-7234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT67007434OtherDRIVER LICENSE