Provider Demographics
NPI:1033210992
Name:O'NEAL, BEN BONNIE (LPN)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:BONNIE
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 MAYFIELD RD
Mailing Address - Street 2:952
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2266
Mailing Address - Country:US
Mailing Address - Phone:440-442-0743
Mailing Address - Fax:440-442-0905
Practice Address - Street 1:6809 MAYFIELD RD
Practice Address - Street 2:952
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2266
Practice Address - Country:US
Practice Address - Phone:440-442-0743
Practice Address - Fax:440-442-0905
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN108513164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHIP#2432424Medicaid