Healthcare Provider Details

I. General information

NPI: 1295644961
Provider Name (Legal Business Name): GRACE NINNEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 VIRGINIA AVE
DAYTON OH
45410-2316
US

IV. Provider business mailing address

140 VIRGINIA AVE
DAYTON OH
45410-2316
US

V. Phone/Fax

Practice location:
  • Phone: 937-626-7512
  • Fax:
Mailing address:
  • Phone: 937-626-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberRK780730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: