Provider Demographics
NPI:1861094872
Name:FOGLE, JOY MARIA
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:MARIA
Last Name:FOGLE
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 1:118 BEATTY AVE
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43344-1006
Mailing Address - Country:US
Mailing Address - Phone:937-243-6486
Mailing Address - Fax:
Practice Address - Street 1:118 BEATTY AVE
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43344-1006
Practice Address - Country:US
Practice Address - Phone:937-243-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8002360Medicaid