Individual
CASEY LAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 ELIZABETH PL, DAYTON, OH 45417-3445
(937) 813-1737
Mailing address
4569 CEMETERY RD, SAINT PARIS, OH 43072-9323
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
406040
OH
Other
Enumeration date
02/23/2022
Last updated
02/23/2022
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