Healthcare Provider Details

I. General information

NPI: 1457104143
Provider Name (Legal Business Name): AUDREY E MCCLURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5897 E WOODMONT AVE
CINCINNATI OH
45213-2007
US

IV. Provider business mailing address

5897 E WOODMONT AVE
CINCINNATI OH
45213-2007
US

V. Phone/Fax

Practice location:
  • Phone: 513-846-6903
  • Fax:
Mailing address:
  • Phone:
  • 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 Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: