MEDICARE: DIOJENIA LEVON KERLEY STNA

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	602705600923	OH

General Provider Information

NPI Number	:	1568292670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIOJENIA LEVON KERLEY STNA

Provider Business Mailing Address
First Line	:	3044 JEWELSTONE DR APT 201
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-2750
Country	:	US
Telephone Number	:	937-271-0465
Fax Number	:

Provider Business Practice Location Address
First Line	:	3044 JEWELSTONE DR APT 201
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-2750
Country	:	US
Telephone Number	:	937-271-0465
Fax Number	:

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

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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