Individual
JEANINE MARIE PHARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ISP
Contact information
Practice address
836 XENIA AVE, XENIA, OH 45385-5158
(937) 768-0559
Mailing address
836 XENIA AVE, XENIA, OH 45385-5158
(937) 768-0559
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
RQ540121
OH
374U00000X
Home Health Aide
—
OH
376J00000X
Homemaker
RQ540121
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109402347899
—
OH
05
—
2-10086
—
OH
Enumeration date
11/17/2020
Last updated
11/17/2020
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