Healthcare Provider Details

I. General information

NPI: 1033666516
Provider Name (Legal Business Name): LANNA DAUGHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 PARRETT RD
GREENFIELD OH
45123
US

IV. Provider business mailing address

128 PARRETT RD
GREENFIELD OH
45123-9531
US

V. Phone/Fax

Practice location:
  • Phone: 937-509-8045
  • Fax:
Mailing address:
  • Phone: 937-509-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: