Provider Demographics
NPI:1609671254
Name:CERTAIN, DESERA D
Entity type:Individual
Prefix:MRS
First Name:DESERA
Middle Name:D
Last Name:CERTAIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30221 HAYNES HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:OH
Mailing Address - Zip Code:45647-8811
Mailing Address - Country:US
Mailing Address - Phone:740-710-0076
Mailing Address - Fax:
Practice Address - Street 1:30221 HAYNES HOLLOW RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:OH
Practice Address - Zip Code:45647-8811
Practice Address - Country:US
Practice Address - Phone:740-710-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide