Healthcare Provider Details

I. General information

NPI: 1245656123
Provider Name (Legal Business Name): MISS KASSANDRA A TUREK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2014
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 S MARION ST
BLOOMVILLE OH
44818-9201
US

IV. Provider business mailing address

58 S MARION ST
BLOOMVILLE OH
44818-9201
US

V. Phone/Fax

Practice location:
  • Phone: 567-230-0017
  • Fax: 419-983-2711
Mailing address:
  • Phone: 567-230-0017
  • Fax: 419-983-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: