Healthcare Provider Details

I. General information

NPI: 1295000669
Provider Name (Legal Business Name): LUCINDA GAIL YEAGLE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2012
Last Update Date: 03/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 LAKEVIEW DR
SOUTH VIENNA OH
45369-9738
US

IV. Provider business mailing address

1924 LAKEVIEW DR
SOUTH VIENNA OH
45369-9738
US

V. Phone/Fax

Practice location:
  • Phone: 937-631-4295
  • Fax:
Mailing address:
  • Phone: 937-631-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.137647-M-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: