Individual
CHAVONN L DEDEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5495 BROADWAY, MERRILLVILLE, IN 46410-1647
(219) 884-4900
Mailing address
4187 JEFFERSON ST, GARY, IN 46408-2833
(708) 271-3973
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28246104A
IN
164W00000X
Licensed Practical Nurse
27071592A
IN
363LF0000X
Family Nurse Practitioner
Primary
F03240103
IN
Other
Enumeration date
08/04/2015
Last updated
03/20/2024
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