Healthcare Provider Details

I. General information

NPI: 1912379470
Provider Name (Legal Business Name): DORA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11936 WINCANTON DR
CINCINNATI OH
45231-1051
US

IV. Provider business mailing address

11936 WINCANTON DR
CINCINNATI OH
45231-1051
US

V. Phone/Fax

Practice location:
  • Phone: 513-485-9098
  • Fax:
Mailing address:
  • Phone: 513-485-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number246062
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number246062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: