Provider Demographics
NPI:1609353671
Name:FUQUA, DANIELLE GENTIA
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:GENTIA
Last Name:FUQUA
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 1:1721 MINION AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45205-1058
Mailing Address - Country:US
Mailing Address - Phone:513-252-5715
Mailing Address - Fax:
Practice Address - Street 1:1721 MINION AVE APT 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-1058
Practice Address - Country:US
Practice Address - Phone:513-252-5715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid