Individual
DIAMONDS BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2532 WOODMAN CENTER DR, KETTERING, OH 45420
(937) 739-7100
Mailing address
314 CARTERS GROVE RD, CENTERVILLE, OH 45459-2512
(513) 693-9215
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN.157504.MEDS-IV
OH
Other
Enumeration date
06/17/2022
Last updated
07/12/2022
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