Healthcare Provider Details

I. General information

NPI: 1427529676
Provider Name (Legal Business Name): MISS CANDIS D COPES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4968 GLENWAY AVE
CINCINNATI OH
45238-3902
US

IV. Provider business mailing address

4968 GLENWAY AVE
CINCINNATI OH
45238-3902
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-6575
  • Fax: 513-471-8080
Mailing address:
  • Phone: 513-853-6575
  • Fax: 513-853-6575

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: