Healthcare Provider Details

I. General information

NPI: 1518329291
Provider Name (Legal Business Name): TINA DEHART-WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST FIVE RIVERS HEALTH CENTERS/CENTER FOR WOMENS'HEALTH
DAYTON OH
45409-2722
US

IV. Provider business mailing address

1 WYOMING ST FIVE RIVERS HEALTH CENTERS/CENTER FOR WOMENS'HEALTH
DAYTON OH
45409-2722
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 325202
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: