Healthcare Provider Details

I. General information

NPI: 1124357827
Provider Name (Legal Business Name): ANITRA RENE LATHAM DODD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 06/12/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6362 SAVANNAH AVE
CINCINNATI OH
45224-1918
US

IV. Provider business mailing address

6362 SAVANNAH AVE
CINCINNATI OH
45224-1918
US

V. Phone/Fax

Practice location:
  • Phone: 513-568-2036
  • Fax:
Mailing address:
  • Phone: 513-568-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: