MEDICARE: KANESHA WOODS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1528801180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANESHA WOODS

Provider Business Mailing Address
First Line	:	931 DEBBIE CT
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-2120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 DEBBIE CT
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-2120
Country	:	US
Telephone Number	:	937-245-2365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	06/13/2024

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Directions to “ KANESHA WOODS ” Practice Location

Language	Start Address	Practice Location

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