MEDICARE: DOMONIQUE MICHELLE VENABLE

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	3747P1801X	Personal Care Attendant		OH

General Provider Information

NPI Number	:	1346766417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMONIQUE MICHELLE VENABLE

Provider Business Mailing Address
First Line	:	1103 DETROIT AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44502-2811
Country	:	US
Telephone Number	:	330-559-5987
Fax Number	:

Provider Business Practice Location Address
First Line	:	1103 DETROIT AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44502-2811
Country	:	US
Telephone Number	:	330-559-5987
Fax Number	:

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

Provider Enumeration Date	:	08/20/2017
Last Update Date	:	08/20/2017

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Directions to “ DOMONIQUE MICHELLE VENABLE ” Practice Location

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