MEDICARE: MS. EDONIA DIANE ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	401954700417	OH

General Provider Information

NPI Number	:	1023755444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EDONIA DIANE ANDERSON

Provider Business Mailing Address
First Line	:	6818 ACRE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-5512
Country	:	US
Telephone Number	:	513-620-0382
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 LIVINGSTON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-3731
Country	:	US
Telephone Number	:	513-245-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	05/17/2022

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