Individual
DAVA J DERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1250 NATIONAL RD, SUITE 400, CLAYTON, OH 45315-9505
(937) 836-5165
(937) 836-6709
Mailing address
1250 NATIONAL RD, SUITE 400, CLAYTON, OH 45315-9505
(937) 836-5165
(937) 836-6709
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP06888
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000292814
ANTHEM
OH
05
—
2372418
—
OH
01
—
P00186293
RR MEDICARE
OH
Enumeration date
07/15/2005
Last updated
02/14/2014
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