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Individual

CORNEISHA LATRAY TIDWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
443 BALLYCLARE TER, CINCINNATI, OH 45240-4001
(513) 372-2371
Mailing address
443 BALLYCLARE TER, CINCINNATI, OH 45240-4001
(513) 372-2371

Taxonomy

Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
40088591009
OH

Other

Enumeration date
12/10/2020
Last updated
12/10/2020
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