MEDICARE: VONSHANAE BASS

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1932821352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VONSHANAE BASS

Provider Business Mailing Address
First Line	:	5159 KINGSFORD DR
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-1925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5159 KINGSFORD DR
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-1925
Country	:	US
Telephone Number	:	305-801-7757
Fax Number	:

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

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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Directions to “ VONSHANAE BASS ” Practice Location

Language	Start Address	Practice Location

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