Provider Demographics
NPI:1437447703
Name:BLAINE, DANA MICHELE (CNA, HHA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELE
Last Name:BLAINE
Suffix:
Gender:F
Credentials:CNA, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PATTERSON VILLAGE DR
Mailing Address - Street 2:APT. 2
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-4214
Mailing Address - Country:US
Mailing Address - Phone:937-414-3605
Mailing Address - Fax:
Practice Address - Street 1:14 PATTERSON VILLAGE DR
Practice Address - Street 2:APT. 2
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-4214
Practice Address - Country:US
Practice Address - Phone:937-414-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide