Healthcare Provider Details

I. General information

NPI: 1043911266
Provider Name (Legal Business Name): DIVINE UWASE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 LORD FITZWALTER DR
MIAMISBURG OH
45342-2059
US

IV. Provider business mailing address

1823 LORD FITZWALTER DR
MIAMISBURG OH
45342-2059
US

V. Phone/Fax

Practice location:
  • Phone: 513-344-3796
  • Fax:
Mailing address:
  • Phone: 513-344-3796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: