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General NPI Number Information
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NPI Number | 1679895981
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Entity Type | Individual
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Provider Name | MISTY DAWN FOX
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Gender | Female
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Dates
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Enumeration Date | 02/28/2010
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Last Update Date | 02/28/2010
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Provider Practice Location Address
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Address Line | 7117 COUNTY ROAD 59 LOT 129
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City | MANSFIELD
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State | OH
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Zip | 44904-8512
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Country | US
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Telephone | 419-295-5040
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Fax |
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Provider Business Mailing Address
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Address Line | 7117 COUNTY ROAD 59 LOT 129
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City | MANSFIELD
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State | OH
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Zip | 44904-8512
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Country | US
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Telephone | 419-295-5040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 400272730803
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License Number State | OH
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