Healthcare Provider Details

I. General information

NPI: 1497586820
Provider Name (Legal Business Name): DESTINEE CREMEANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 TOWNSHIP ROAD 177
WILLOW WOOD OH
45696-9057
US

IV. Provider business mailing address

2589 TOWNSHIP ROAD 177
WILLOW WOOD OH
45696-9057
US

V. Phone/Fax

Practice location:
  • Phone: 740-547-4474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: