Provider Demographics
NPI:1841982188
Name:WILLOUGHBY, CEARA JAN'EE I
Entity type:Individual
Prefix:
First Name:CEARA
Middle Name:JAN'EE
Last Name:WILLOUGHBY
Suffix:I
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 1:288 DICKEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2733
Mailing Address - Country:US
Mailing Address - Phone:330-766-9950
Mailing Address - Fax:
Practice Address - Street 1:288 DICKEY AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2733
Practice Address - Country:US
Practice Address - Phone:330-766-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRZ534240172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty