Provider Demographics
NPI:1972808848
Name:DUNAMIS AUXANO LLC
Entity Type:Organization
Organization Name:DUNAMIS AUXANO LLC
Other - Org Name:FAMILY HEALTH AND HEALING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:740-507-7428
Mailing Address - Street 1:121 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44842-1247
Mailing Address - Country:US
Mailing Address - Phone:419-994-0212
Mailing Address - Fax:419-994-0215
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44842-1247
Practice Address - Country:US
Practice Address - Phone:419-994-0212
Practice Address - Fax:419-994-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA11616-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3091238Medicaid
OH3091238Medicaid