MEDICARE: ANITRA RENE LATHAM DODD

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
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1124357827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITRA RENE LATHAM DODD

Provider Business Mailing Address
First Line	:	6362 SAVANNAH AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1918
Country	:	US
Telephone Number	:	513-568-2036
Fax Number	:

Provider Business Practice Location Address
First Line	:	6362 SAVANNAH AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1918
Country	:	US
Telephone Number	:	513-568-2036
Fax Number	:

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

Provider Enumeration Date	:	12/09/2009
Last Update Date	:	06/12/2024

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