Healthcare Provider Details

I. General information

NPI: 1811071301
Provider Name (Legal Business Name): PORNPIMOL NINLAWONG LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 12/07/2025
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

2842 SPRING VALLEY RD
MIAMISBURG OH
45342-4442
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax:
Mailing address:
  • Phone: 937-436-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN109142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: