Independent Provider
NPI #1699178723 in Dayton, Ohio
Provider Information
- NPI Number
- 1699178723
- Entity Type
- Organization
- Organization Name
- Independent Provider
- Primary Specialty
- Preferred Provider Organization
- Enumeration Date
- Oct 3, 2014
- Last Updated
- Oct 3, 2014
Practice Location
Authorized Official
- Name
- LA'TASHA DENISE LEE
- Title
- INDEPENDENT PROVIDER
- Phone
- (979) 451-3843
Specialties & Taxonomy Codes
| Specialty |
|---|
| Preferred Provider Organization |
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