Healthcare Provider Details

I. General information

NPI: 1477387314
Provider Name (Legal Business Name): HARLEY MARIE LAMBERT STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 W LINE ST
MINERVA OH
44657-1649
US

IV. Provider business mailing address

310 BEECHWOOD ST
LOUISVILLE OH
44641-8976
US

V. Phone/Fax

Practice location:
  • Phone: 330-868-8658
  • Fax:
Mailing address:
  • Phone: 330-868-8658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number602583701122
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: