Provider Demographics
NPI:1871219360
Name:CZECH DYDO, DENISE ANN
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:CZECH DYDO
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 1:1130 LAKE MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-5304
Mailing Address - Country:US
Mailing Address - Phone:216-538-0206
Mailing Address - Fax:
Practice Address - Street 1:1130 LAKE MEADOW LN
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-5304
Practice Address - Country:US
Practice Address - Phone:216-538-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker