Healthcare Provider Details

I. General information

NPI: 1346932027
Provider Name (Legal Business Name): EMERALD DENNIS DSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5862 RHODE ISLAND AVE
CINCINNATI OH
45237-5406
US

IV. Provider business mailing address

5862 RHODE ISLAND AVE
CINCINNATI OH
45237-5406
US

V. Phone/Fax

Practice location:
  • Phone: 513-289-5975
  • Fax:
Mailing address:
  • Phone: 513-289-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberSY252733
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number600019630523
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: