Healthcare Provider Details

I. General information

NPI: 1124628342
Provider Name (Legal Business Name): DENISE JUSTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 KENMORE BLVD
AKRON OH
44314-1964
US

IV. Provider business mailing address

1246 KENMORE BLVD
AKRON OH
44314-1964
US

V. Phone/Fax

Practice location:
  • Phone: 234-900-9377
  • Fax:
Mailing address:
  • Phone: 234-900-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: