MEDICARE: JESSICA LILLIEFAYE DINGUS

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	402000960817	OH

General Provider Information

NPI Number	:	1447014956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LILLIEFAYE DINGUS

Provider Business Mailing Address
First Line	:	26 HALL RD
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-9045
Country	:	US
Telephone Number	:	937-690-9160
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 RHODES AVE APT 509
Second Line	:
City	:	NEW BOSTON
State	:	OH
Zip	:	45662-4958
Country	:	US
Telephone Number	:	740-935-1122
Fax Number	:

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

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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