Healthcare Provider Details

I. General information

NPI: 1194987172
Provider Name (Legal Business Name): LORA LYNN FIELDING AID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 01/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E COLUMBUS RD APT 214
SOUTH CHARLESTON OH
45368-9335
US

IV. Provider business mailing address

5680 CALLAHAN RD
SOUTH VIENNA OH
45369-9715
US

V. Phone/Fax

Practice location:
  • Phone: 937-462-7420
  • Fax:
Mailing address:
  • Phone: 937-408-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: