Provider Demographics
NPI:1154617975
Name:CROAKE, DOROTHY
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:
Last Name:CROAKE
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 1:7137 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3426
Mailing Address - Country:US
Mailing Address - Phone:513-407-7399
Mailing Address - Fax:
Practice Address - Street 1:7137 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3426
Practice Address - Country:US
Practice Address - Phone:513-407-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2993793374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2993793Medicaid