Provider Demographics
NPI:1811777071
Name:DUCKWORTH, CHINARA KIOWNI
Entity type:Individual
Prefix:
First Name:CHINARA
Middle Name:KIOWNI
Last Name:DUCKWORTH
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 1:5943 LUCKY CHARM DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9111
Mailing Address - Country:US
Mailing Address - Phone:330-787-3370
Mailing Address - Fax:
Practice Address - Street 1:5943 LUCKY CHARM DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9111
Practice Address - Country:US
Practice Address - Phone:330-787-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide