Provider Demographics
NPI:1336903848
Name:WILLWOHL GASTON SERRA, FATIMA
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:WILLWOHL GASTON SERRA
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 1:522 CURRY DR
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-6500
Mailing Address - Country:US
Mailing Address - Phone:334-740-7534
Mailing Address - Fax:
Practice Address - Street 1:522 CURRY DR
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-6500
Practice Address - Country:US
Practice Address - Phone:334-740-7534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver