| Doctor Name: | DEANNA DOUGLAS |
| NPI Number: | 1740602101 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CERTIFIED HAIR LOSS |
| License Number: | 32WG06329200 |
| Business Practice Address: | 1009 Walnut Ln Mullica Hill, NJ - 080622050 |
| Business Phone Number: | 8564173907 |
| Business Fax Number: | |
| Mailing Address: | 631 White Horse Pike, HADDON TOWNSHIP |
| State: | NJ |
| Postal Code: | 081071246 |
| Phone Number: | 8564958108 |
| Fax Number: | |
| NPI Enumeration Date: | 01/20/2014 |
| NPI Last Update Date: | 01/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1744P3200X |
| License Number: | 32WG06329200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | Prosthetics Case Management |
| Taxonomy Definition: | |