Individual
MS. EARLENE FAY WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
713 WAYCROSS RD APT A, CINCINNATI, OH 45240-3288
(513) 557-1048
Mailing address
713 WAYCROSS RD APT A, CINCINNATI, OH 45240-3288
(513) 557-1048
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
104497001
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2654908
—
OH
Enumeration date
02/09/2017
Last updated
02/09/2017
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