Provider Demographics
NPI:1811584865
Name:DUNAWAY, ROBERTA C
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:C
Last Name:DUNAWAY
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 1:1105 MARTZ DR
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-3115
Mailing Address - Country:US
Mailing Address - Phone:937-541-1605
Mailing Address - Fax:
Practice Address - Street 1:1105 MARTZ DR
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-3115
Practice Address - Country:US
Practice Address - Phone:937-541-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide