Healthcare Provider Details

I. General information

NPI: 1841037470
Provider Name (Legal Business Name): DORIS PUTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 MAJESTIC DR
DAYTON OH
45417-8925
US

IV. Provider business mailing address

573 MAJESTIC DR
DAYTON OH
45417-8925
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-0392
  • Fax: 937-723-9960
Mailing address:
  • Phone: 937-461-0392
  • Fax: 937-723-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: