Provider Demographics
NPI:1184215956
Name:ADY, JUNE ANN
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:ANN
Last Name:ADY
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 1:46763 TOWNSHIP ROAD 45A
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43754-9524
Mailing Address - Country:US
Mailing Address - Phone:740-472-5735
Mailing Address - Fax:740-472-5735
Practice Address - Street 1:46763 TOWNSHIP ROAD 45A
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:OH
Practice Address - Zip Code:43754-9524
Practice Address - Country:US
Practice Address - Phone:740-472-5735
Practice Address - Fax:740-472-5735
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2258391Medicaid