Healthcare Provider Details

I. General information

NPI: 1659977403
Provider Name (Legal Business Name): LYDIA RAMTHUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ANDREW CT E
LONDON OH
43140-9051
US

IV. Provider business mailing address

102 ANDREW CT E
LONDON OH
43140-9051
US

V. Phone/Fax

Practice location:
  • Phone: 937-207-3273
  • Fax:
Mailing address:
  • Phone: 937-207-3273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: