Healthcare Provider Details

I. General information

NPI: 1265597116
Provider Name (Legal Business Name): ANTWIN ANTONIO CAUSEY STNA-NURSE AIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANTWIN ANTONIO CAUSEY MR. ANTWIN A CAUSEY

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 WILSON AVE 2861 WILSON AVE.
CINCINNATI OH
45251-1070
US

IV. Provider business mailing address

2861 WILSON AVE 2861 WILSON AVENUE
CINCINNATI OH
45251-1070
US

V. Phone/Fax

Practice location:
  • Phone: 513-674-7454
  • Fax:
Mailing address:
  • Phone: 513-674-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400469610305
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: