Provider Demographics
NPI:1902173701
Name:SOLE PROPRIETORSHIP
Entity type:Organization
Organization Name:SOLE PROPRIETORSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:AZELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKUZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-746-1682
Mailing Address - Street 1:45 CLEARCREEK FRANKLIN RD APT 11
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9348
Mailing Address - Country:US
Mailing Address - Phone:937-746-1682
Mailing Address - Fax:
Practice Address - Street 1:45 CLEARCREEK FRANKLIN RD APT 11
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9348
Practice Address - Country:US
Practice Address - Phone:937-746-1682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH354649251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health