Healthcare Provider Details

I. General information

NPI: 1033962816
Provider Name (Legal Business Name): JENEVIEVE PILAR DERSAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 WESTVIEW DR
LANCASTER OH
43130-2878
US

IV. Provider business mailing address

437 WESTVIEW DR
LANCASTER OH
43130-2878
US

V. Phone/Fax

Practice location:
  • Phone: 740-823-2731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: