Healthcare Provider Details

I. General information

NPI: 1437746914
Provider Name (Legal Business Name): CYRILLIA LUCILLE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 N HIGH ST, COLUMBUS COLUMBUS
COLUMBUS OH
43201
US

IV. Provider business mailing address

5223 OHIO ST APARTNENT #1 SOUTH CHARLESTON
VIRGINIA WV
25309
US

V. Phone/Fax

Practice location:
  • Phone: 614-294-2105
  • Fax:
Mailing address:
  • Phone: 937-931-5601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN207010
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: