Healthcare Provider Details

I. General information

NPI: 1962972760
Provider Name (Legal Business Name): CIERRA M VREHOUROU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 09/02/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4761 STATE ROUTE 29
CELINA OH
45822-8216
US

IV. Provider business mailing address

4761 STATE ROUTE 29
CELINA OH
45822-8216
US

V. Phone/Fax

Practice location:
  • Phone: 419-584-1000
  • Fax: 419-584-1825
Mailing address:
  • Phone: 419-584-1000
  • Fax: 419-584-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: