Provider Demographics
NPI:1043911266
Name:UWASE, DIVINE
Entity Type:Individual
Prefix:
First Name:DIVINE
Middle Name:
Last Name:UWASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 LORD FITZWALTER DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-2059
Mailing Address - Country:US
Mailing Address - Phone:513-344-3796
Mailing Address - Fax:
Practice Address - Street 1:1823 LORD FITZWALTER DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-2059
Practice Address - Country:US
Practice Address - Phone:513-344-3796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker