Provider Demographics
NPI:1184113938
Name:HUFFAKER, DAISY O
Entity type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:O
Last Name:HUFFAKER
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 1:723 TIOGA TRAIL
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7228
Mailing Address - Country:US
Mailing Address - Phone:440-479-5672
Mailing Address - Fax:
Practice Address - Street 1:723 TIOGA TRAIL
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7228
Practice Address - Country:US
Practice Address - Phone:440-479-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0192855Medicaid