Healthcare Provider Details

I. General information

NPI: 1245457621
Provider Name (Legal Business Name): KATE AWELE ANENE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 ALGOMA ST
DAYTON OH
45415-2407
US

IV. Provider business mailing address

5908 ALGOMA ST
DAYTON OH
45415-2407
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-1992
  • Fax: 937-278-1992
Mailing address:
  • Phone: 937-278-1992
  • Fax: 937-278-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number325611
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: