Provider Demographics
NPI:1427811652
Name:CANTRELL, CECILIA RENEE
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:RENEE
Last Name:CANTRELL
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 1:730 GRAVEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OH
Mailing Address - Zip Code:45613-9515
Mailing Address - Country:US
Mailing Address - Phone:740-352-5936
Mailing Address - Fax:
Practice Address - Street 1:730 GRAVEL HILL RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OH
Practice Address - Zip Code:45613-9515
Practice Address - Country:US
Practice Address - Phone:740-352-5936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program