Individual
COURTNEY CISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
208 RAYMER BLVD, TOLEDO, OH 43605-1720
(419) 245-8400
Mailing address
208 RAYMER BLVD, TOLEDO, OH 43605-1720
(419) 245-8400
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
360013
—
OH
Enumeration date
06/08/2018
Last updated
06/08/2018
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