Individual
MISS CHENITA DAWN GILLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
260 E COOK RD, APT 109, MANSFIELD, OH 44907
(419) 756-5137
Mailing address
768 MCPHERSON ST, MANSFIELD, OH 44903-7139
(567) 241-3051
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2705228
IP
OH
01
—
400552411106
STNA
OH
Enumeration date
04/26/2007
Last updated
08/30/2023
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