Individual
IRENE E DETTMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
275 GRAHAM RD, SUITE 4, CUYAHOGA FALLS, OH 44223-2203
(330) 926-9409
(330) 926-9428
Mailing address
1990 MAHONING RD, DEERFIELD, OH 44411-8735
(330) 654-2646
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
NP 04647
OH
363L00000X
Nurse Practitioner
Primary
RN 110530
OH
363LA2200X
Adult Health Nurse Practitioner
NP04647
OH
363LA2200X
Adult Health Nurse Practitioner
RN 110530
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000323216
BC BS
OH
05
—
2096253
—
OH
01
—
27YY61105006
MEDICAL MUTUAL
OH
Enumeration date
08/15/2005
Last updated
11/23/2007
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