Provider Demographics
NPI:1033384680
Name:KINDO, GLORY AMBANG (LPN)
Entity Type:Individual
Prefix:MISS
First Name:GLORY
Middle Name:AMBANG
Last Name:KINDO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:GLORY
Other - Middle Name:AMBANG
Other - Last Name:TACHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:891 WAYCROSS RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3129
Mailing Address - Country:US
Mailing Address - Phone:513-236-5660
Mailing Address - Fax:
Practice Address - Street 1:891 WAYCROSS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3129
Practice Address - Country:US
Practice Address - Phone:513-236-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-111570164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse