Basic Information
Provider Information
NPI: 1144953712
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILL
FirstName: DAWN
MiddleName: LOUISE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 615 ELSINORE PL STE 200
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452021457
CountryCode: US
TelephoneNumber: 8335104357
FaxNumber:  
Practice Location
Address1: 5850 RIDGE RD
Address2:  
City: PARMA
State: OH
PostalCode: 441293169
CountryCode: US
TelephoneNumber: 8335104357
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/01/2022
LastUpdateDate: 07/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN.434689OHY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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