MEDICARE: DEMETRIUS KAHNE NEWLUN

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	374U00000X	Home Health Aide	VB313722	OH

General Provider Information

NPI Number	:	1255175576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRIUS KAHNE NEWLUN

Provider Business Mailing Address
First Line	:	2944 TOWNSHIP ROAD 186 SW
Second Line	:
City	:	JUNCTION CITY
State	:	OH
Zip	:	43748-9746
Country	:	US
Telephone Number	:	740-605-0436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2944 TOWNSHIP ROAD 186 SW
Second Line	:
City	:	JUNCTION CITY
State	:	OH
Zip	:	43748-9746
Country	:	US
Telephone Number	:	740-605-0436
Fax Number	:

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

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	06/21/2024

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Directions to “ DEMETRIUS KAHNE NEWLUN ” Practice Location

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