Individual
LUDIVIA MAE BLOSSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7700 JEFFERS RD, WHITEHOUSE, OH 43571-9822
(419) 509-7056
Mailing address
7700 JEFFERS RD, WHITEHOUSE, OH 43571-9822
(419) 509-7056
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4810382
—
OH
Enumeration date
08/12/2022
Last updated
08/12/2022
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