Most Relevant Information
Provider Data
| NPI Number: | 1003657842 |
| Provider Name: | KORISSA JEAN VAN OVER |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/05/2024 |
| Last Updated: | 06/05/2024 |
Provider Practice Location
1084 S MAIN ST STE A
BOWLING GREEN
OH
434024740
Practice Location Phone/Fax
| Phone: | 4193524624 |
| Fax: | 4199367606 |
Provider Mailing Location
1425 STARR AVE
TOLEDO
OH
436052456
Provider Mailing Phone/Fax
| Phone: | 4196930631 |
| Fax: | 4199367606 |