Healthcare Provider Details

I. General information

NPI: 1285909879
Provider Name (Legal Business Name): DENISE SLINE TARVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 MARTHA AVE
CAMPBELL OH
44405-1130
US

IV. Provider business mailing address

685 MARTHA AVE
CAMPBELL OH
44405-1130
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-2716
  • Fax:
Mailing address:
  • Phone: 330-743-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401300970911
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: