Healthcare Provider Details

I. General information

NPI: 1851795496
Provider Name (Legal Business Name): RHONDA FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S. MAIN STREET
GREENVILLE OH
45331
US

IV. Provider business mailing address

7305 E STATE RD. 28
UNION CITY IN
47390
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-1635
  • Fax:
Mailing address:
  • Phone: 937-417-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1450375
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: