Provider Demographics
NPI:1356119325
Name:PURBAUGH, JOHANNE SCOTT
Entity type:Individual
Prefix:
First Name:JOHANNE
Middle Name:SCOTT
Last Name:PURBAUGH
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 1:643 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1136
Mailing Address - Country:US
Mailing Address - Phone:151-361-6744
Mailing Address - Fax:
Practice Address - Street 1:200 STARCREST DR STE 1203
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-6864
Practice Address - Country:US
Practice Address - Phone:760-391-2483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant