Healthcare Provider Details

I. General information

NPI: 1972320992
Provider Name (Legal Business Name): RADONA SAMPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2024
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 PARKWOOD AVE
TOLEDO OH
43610-1616
US

IV. Provider business mailing address

845 STRAWBERRY HILL RD W
COLUMBUS OH
43213-3428
US

V. Phone/Fax

Practice location:
  • Phone: 419-442-7982
  • Fax:
Mailing address:
  • Phone: 614-599-7562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: