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General NPI Number Information
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NPI Number | 1720734734
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Entity Type | Individual
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Provider Name | VIVA A SHRADER
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Gender | Female
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 1324 SWEITZER ST LOT C3
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City | GREENVILLE
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State | OH
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Zip | 45331-3324
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Country | US
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Telephone | 937-548-3962
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Fax |
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Provider Business Mailing Address
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Address Line | 117 E BROADWAY ST LOT 28
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City | FORT RECOVERY
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State | OH
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Zip | 45846-9318
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Country | US
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Telephone | 937-569-1136
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State | OH
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