Individual
DERRICK EVERETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3719 MIDDLEBRANCH AVE NE, 0, CANTON, OH 44705-5021
(330) 327-0965
Mailing address
3719 MIDDLEBRANCH AVE NE, 0, CANTON, OH 44705-5021
(330) 327-0965
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0093085
—
OH
Enumeration date
06/23/2014
Last updated
06/23/2014
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