MEDICARE: JAWANA SPRINGS

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	401506030413	OH

General Provider Information

NPI Number	:	1114441664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAWANA SPRINGS

Provider Business Mailing Address
First Line	:	506 PROSPECT PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 PROSPECT PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2938
Country	:	US
Telephone Number	:	513-213-1478
Fax Number	:

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

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	07/26/2017

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Directions to “ JAWANA SPRINGS ” Practice Location

Language	Start Address	Practice Location

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