MEDICARE: NNODUM IHEME R.PH

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
2	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1518415934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NNODUM IHEME R.PH

Provider Business Mailing Address
First Line	:	1130 W 3RD ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-6812
Country	:	US
Telephone Number	:	513-739-6293
Fax Number	:	937-225-9355

Provider Business Practice Location Address
First Line	:	1130 W 3RD ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-6812
Country	:	US
Telephone Number	:	513-739-6293
Fax Number	:	937-225-9355

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

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	09/14/2016

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