Provider Demographics
NPI:1346932027
Name:DENNIS, EMERALD (DSP)
Entity Type:Individual
Prefix:
First Name:EMERALD
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5862 RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-5406
Mailing Address - Country:US
Mailing Address - Phone:513-289-5975
Mailing Address - Fax:
Practice Address - Street 1:5862 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-5406
Practice Address - Country:US
Practice Address - Phone:513-289-5975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH600019630523376K00000X
OHSY252733374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide