Provider Demographics
NPI:1235724790
Name:DUBOSE, DARRELL CHANTEZ
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:CHANTEZ
Last Name:DUBOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3854 RIDGECOMBE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-3247
Mailing Address - Country:US
Mailing Address - Phone:513-823-7934
Mailing Address - Fax:
Practice Address - Street 1:91 FARRAGUT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45218-1406
Practice Address - Country:US
Practice Address - Phone:513-728-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide