Individual
ILLATIA COUNCIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6407 S TIMBERIDGE DR, AUSTINTOWN, OH 44515-5551
(330) 519-4619
Mailing address
6407 S TIMBERIDGE DR, AUSTINTOWN, OH 44515-5551
(330) 519-4619
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
501091270306
OH
Other
Enumeration date
08/07/2025
Last updated
08/07/2025
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