Provider Demographics
NPI:1902953821
Name:DIDUSCH, LAURA JANE
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JANE
Last Name:DIDUSCH
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 1:3504 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2013
Mailing Address - Country:US
Mailing Address - Phone:513-451-6109
Mailing Address - Fax:
Practice Address - Street 1:3504 LOCUST LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2013
Practice Address - Country:US
Practice Address - Phone:513-451-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2181713Medicaid