MEDICARE: MARIAH LARELL ANDEBRHAN

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	:	1538919329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH LARELL ANDEBRHAN

Provider Business Mailing Address
First Line	:	3686 WESTWIND DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3530
Country	:	US
Telephone Number	:	937-409-1309
Fax Number	:

Provider Business Practice Location Address
First Line	:	3686 WESTWIND DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3530
Country	:	US
Telephone Number	:	937-409-1309
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	04/07/2026

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