Healthcare Provider Details

I. General information

NPI: 1932807450
Provider Name (Legal Business Name): ANNA LOUISE WYATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 BRIARWOOD AVE APT 3
DAYTON OH
45403-1554
US

IV. Provider business mailing address

423 BRIARWOOD AVE APT 3
DAYTON OH
45403-1554
US

V. Phone/Fax

Practice location:
  • Phone: 937-287-5789
  • Fax:
Mailing address:
  • Phone: 937-603-9357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: