Healthcare Provider Details

I. General information

NPI: 1457542722
Provider Name (Legal Business Name): MVHE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 E DOROTHY LN
KETTERING OH
45420-1176
US

IV. Provider business mailing address

2115 E DOROTHY LN
KETTERING OH
45420-1176
US

V. Phone/Fax

Practice location:
  • Phone: 937-296-1646
  • Fax: 937-296-1647
Mailing address:
  • Phone: 937-296-1646
  • Fax: 937-296-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KENNETH PRUNIER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 937-208-8252