Individual
MS. MARILYN SUE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
81A RHOADS CENTER DR, CENTERVILLE, OH 45458
(800) 538-4218
(937) 435-0980
Mailing address
1704 DOVER AVE, PIQUA, OH 45356-2724
(937) 615-9496
(937) 615-9496
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
400421721004STNA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2604962
CARESTAR
OH
Enumeration date
03/06/2007
Last updated
07/08/2007
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