Provider Demographics
NPI:1730360702
Name:ID-DEEN, YOLANDA DIANE
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:DIANE
Last Name:ID-DEEN
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 1:1221 EVERTON DR
Mailing Address - Street 2:APT 1117
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1468
Mailing Address - Country:US
Mailing Address - Phone:330-371-3554
Mailing Address - Fax:
Practice Address - Street 1:1221 EVERTON DR
Practice Address - Street 2:APT 1117
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1468
Practice Address - Country:US
Practice Address - Phone:330-371-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2756772Medicaid