Healthcare Provider Details

I. General information

NPI: 1871306548
Provider Name (Legal Business Name): BLAYRE IONNA GREENWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 CAMVIC TER APT 10
CINCINNATI OH
45211-3632
US

IV. Provider business mailing address

3321 CAMVIC TER
CINCINNATI OH
45211-3672
US

V. Phone/Fax

Practice location:
  • Phone: 513-879-3617
  • Fax:
Mailing address:
  • Phone: 513-879-3617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number601819330823
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: