PROVIDIAN NPI 1750517793

NPI Information

PROVIDIAN is a public health or welfare in Moraine, OH. PROVIDIAN NPI is 1750517793. The provider is registered as an organization entity type.

The provider's business location address is:

2844 E RIVER RD
MORAINE, OH
ZIP 45439-538
Phone: (937) 603-6643

The provider's authorized official is Shondale Nicole Atkinson .
The authorized official title is C.e.o. and has the following contact phone number (937) 603-6643.

The enumeration date for this NPI number is 6/4/2009 and was last updated on 6/4/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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