Provider Demographics
NPI:1275331258
Name:MANSFIELD, DAJANAE
Entity type:Individual
Prefix:
First Name:DAJANAE
Middle Name:
Last Name:MANSFIELD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 RACINE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2960
Mailing Address - Country:US
Mailing Address - Phone:614-633-8052
Mailing Address - Fax:
Practice Address - Street 1:628 RACINE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2960
Practice Address - Country:US
Practice Address - Phone:614-633-8052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant