Individual
HEATHER A DIOUBATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5316 POPLARWOOD RD, COLUMBUS, OH 43229-4438
(614) 698-6396
Mailing address
5316 POPLARWOOD RD, COLUMBUS, OH 43229-4438
(614) 698-6396
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0086774
—
OH
01
—
2564489
DODD CONTRACT NUMBER
OH
Enumeration date
12/02/2020
Last updated
12/02/2020
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