Healthcare Provider Details

I. General information

NPI: 1336421908
Provider Name (Legal Business Name): JUDITH DIANA VULCAN CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 W OXFORD ST
ALLIANCE OH
44601-2968
US

IV. Provider business mailing address

46 W OXFORD ST
ALLIANCE OH
44601-2968
US

V. Phone/Fax

Practice location:
  • Phone: 330-581-9320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400887370409
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: