Healthcare Provider Details

I. General information

NPI: 1578747549
Provider Name (Legal Business Name): LONJENNA YVETTE HALE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

461 BERNARD CT
DAYTON OH
45427-2714
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-267-7662
Mailing address:
  • Phone: 937-268-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberPN-083005
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: