Provider Demographics
NPI:1841037470
Name:PUTMAN, DORIS
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:PUTMAN
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 1:573 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-8925
Mailing Address - Country:US
Mailing Address - Phone:937-461-0392
Mailing Address - Fax:937-723-9960
Practice Address - Street 1:573 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-8925
Practice Address - Country:US
Practice Address - Phone:937-461-0392
Practice Address - Fax:937-723-9960
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide