MEDICARE: MRS. ALISHA UNDERWOOD

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		OH

General Provider Information

NPI Number	:	1972348365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISHA UNDERWOOD

Provider Business Mailing Address
First Line	:	5858 BLUE SPRUCE LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2856
Country	:	US
Telephone Number	:	513-331-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5858 BLUE SPRUCE LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2856
Country	:	US
Telephone Number	:	513-331-1800
Fax Number	:

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

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	06/27/2024

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