Provider Demographics
NPI:1265597116
Name:CAUSEY, ANTWIN ANTONIO (STNA-NURSE AIDE)
Entity type:Individual
Prefix:MR
First Name:ANTWIN
Middle Name:ANTONIO
Last Name:CAUSEY
Suffix:
Gender:M
Credentials:STNA-NURSE AIDE
Other - Prefix:MR
Other - First Name:ANTWIN
Other - Middle Name:ANTONIO
Other - Last Name:CAUSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MR ANTWIN A CAUSEY
Mailing Address - Street 1:2861 WILSON AVE
Mailing Address - Street 2:2861 WILSON AVENUE
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1070
Mailing Address - Country:US
Mailing Address - Phone:513-674-7454
Mailing Address - Fax:
Practice Address - Street 1:2861 WILSON AVE
Practice Address - Street 2:2861 WILSON AVE.
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1070
Practice Address - Country:US
Practice Address - Phone:513-674-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400469610305376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2586241Medicaid
OH400469610305OtherSTNA-NURSE AIDE