Healthcare Provider Details

I. General information

NPI: 1700089711
Provider Name (Legal Business Name): LUCILA DEL CARMEN MAYSONET LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40850 SLIFE RD
LAGRANGE OH
44050-9827
US

IV. Provider business mailing address

2541 S JEFFERSON BLVD
LORAIN OH
44052-2457
US

V. Phone/Fax

Practice location:
  • Phone: 440-458-4971
  • Fax:
Mailing address:
  • Phone: 440-242-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN116711
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: