Provider Demographics
NPI:1801000831
Name:D'ACQUISTO, KATHERINE CECILIA
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CECILIA
Last Name:D'ACQUISTO
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 1:1117 S FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4037
Mailing Address - Country:US
Mailing Address - Phone:630-290-2970
Mailing Address - Fax:
Practice Address - Street 1:2352 BRADSHIRE RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-5285
Practice Address - Country:US
Practice Address - Phone:937-648-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2618055Medicaid