MEDICARE: EMERALD DENNIS DSP

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	600019630523	OH
2	374U00000X	Home Health Aide	SY252733	OH

General Provider Information

NPI Number	:	1346932027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMERALD DENNIS DSP

Provider Business Mailing Address
First Line	:	5862 RHODE ISLAND AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-5406
Country	:	US
Telephone Number	:	513-289-5975
Fax Number	:

Provider Business Practice Location Address
First Line	:	5862 RHODE ISLAND AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-5406
Country	:	US
Telephone Number	:	513-289-5975
Fax Number	:

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

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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Directions to “ EMERALD DENNIS DSP” Practice Location

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