Provider Demographics
NPI:1447079652
Name:FUGATE, JOSIAH N (RN)
Entity type:Individual
Prefix:
First Name:JOSIAH
Middle Name:N
Last Name:FUGATE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W WENGER RD STE J
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2755
Mailing Address - Country:US
Mailing Address - Phone:937-654-8668
Mailing Address - Fax:937-771-0031
Practice Address - Street 1:12 W WENGER RD STE J
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2755
Practice Address - Country:US
Practice Address - Phone:937-654-8668
Practice Address - Fax:937-771-0031
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347999163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health