Provider Demographics
NPI:1841898483
Name:HOUSE, DAVID WAYNE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:HOUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:THURMAN
Mailing Address - State:OH
Mailing Address - Zip Code:45685-0009
Mailing Address - Country:US
Mailing Address - Phone:740-853-0826
Mailing Address - Fax:
Practice Address - Street 1:205 BROAD STREET
Practice Address - Street 2:
Practice Address - City:THURMAN
Practice Address - State:OH
Practice Address - Zip Code:45685-0009
Practice Address - Country:US
Practice Address - Phone:740-853-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide