Healthcare Provider Details

I. General information

NPI: 1215538368
Provider Name (Legal Business Name): DAWIT W OUKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DUNBAR PLZ STE 200
DUNBAR WV
25064-3038
US

IV. Provider business mailing address

1560 WASHINGTON ST E
CHARLESTON WV
25311-2518
US

V. Phone/Fax

Practice location:
  • Phone: 304-342-5839
  • Fax:
Mailing address:
  • Phone: 443-473-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: