Healthcare Provider Details

I. General information

NPI: 1639487192
Provider Name (Legal Business Name): PATRICIA ANNE CASKEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 PENN LINE RD
PIERPONT OH
44082-9730
US

IV. Provider business mailing address

612 PENN LINE RD
PIERPONT OH
44082-9730
US

V. Phone/Fax

Practice location:
  • Phone: 440-577-1267
  • Fax:
Mailing address:
  • Phone: 440-577-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 101497 IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: