Provider Demographics
NPI:1720694441
Name:DAWES-WILLIS, CAROL JEAN
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:DAWES-WILLIS
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 1:8477 DUNHAM RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-6674
Mailing Address - Country:US
Mailing Address - Phone:937-764-1485
Mailing Address - Fax:
Practice Address - Street 1:8477 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-6674
Practice Address - Country:US
Practice Address - Phone:937-764-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056416Medicaid