Healthcare Provider Details

I. General information

NPI: 1659986651
Provider Name (Legal Business Name): JAMES DUNN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4162 LAURELL LN
NORTH OLMSTED OH
44070-2551
US

IV. Provider business mailing address

4162 LAURELL LN
NORTH OLMSTED OH
44070-2551
US

V. Phone/Fax

Practice location:
  • Phone: 144-077-7846
  • Fax:
Mailing address:
  • Phone: 144-077-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number0059041
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number0059041
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: