Provider Demographics
NPI:1437746914
Name:ANDERSON, CYRILLIA LUCILLE
Entity Type:Individual
Prefix:
First Name:CYRILLIA
Middle Name:LUCILLE
Last Name:ANDERSON
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 1:5223 OHIO ST
Mailing Address - Street 2:APARTNENT #1 SOUTH CHARLESTON
Mailing Address - City:VIRGINIA
Mailing Address - State:WV
Mailing Address - Zip Code:25309
Mailing Address - Country:US
Mailing Address - Phone:937-931-5601
Mailing Address - Fax:
Practice Address - Street 1:2160 N HIGH ST, COLUMBUS
Practice Address - Street 2:COLUMBUS
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201
Practice Address - Country:US
Practice Address - Phone:614-294-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN207010163WC0400X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty