MEDICARE: MRS. TONEKA EDMERSON

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	374U00000X	Home Health Aide		OH

General Provider Information

NPI Number	:	1568032993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONEKA EDMERSON

Provider Business Mailing Address
First Line	:	7710 READING RD STE 107A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2809
Country	:	US
Telephone Number	:	513-413-8823
Fax Number	:	513-672-9901

Provider Business Practice Location Address
First Line	:	7710 READING RD STE 107A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2809
Country	:	US
Telephone Number	:	513-413-8823
Fax Number	:	513-672-9901

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

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	06/28/2021

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