Individual
KATISH TANA BEASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
221 FIELDSTONE DR APT 3, TROTWOOD, OH 45426-6817
(937) 270-0078
Mailing address
221 FIELDSTONE DR APT 3, TROTWOOD, OH 45426-6817
(937) 270-0078
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0063557
PROVIDER NUMBER
OH
Enumeration date
09/04/2014
Last updated
09/04/2014
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