Individual
DWAYNE WILLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
675 PENNY LN S, GAHANNA, OH 43230-2348
(614) 732-9617
Mailing address
675 PENNY LN S, GAHANNA, OH 43230-2348
(614) 732-9617
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
400991311009
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102428929899
—
OH
Enumeration date
07/08/2014
Last updated
07/08/2014
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