Individual
EMELDA C NGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1390 KING TREE DR, DAYTON, OH 45405-1401
(540) 793-1845
Mailing address
3895 MACK RD, #110, FAIRFIELD, OH 45014-7655
(513) 942-0227
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OT . 006484
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MEDICARE
—
OH
Enumeration date
05/07/2009
Last updated
05/07/2009
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