Provider Demographics
NPI:1043550106
Name:RESTREPO, WILLIAM (LPN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:RESTREPO
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 1:213 E BOWMAN ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-3535
Mailing Address - Country:US
Mailing Address - Phone:330-988-6149
Mailing Address - Fax:
Practice Address - Street 1:213 E BOWMAN ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3535
Practice Address - Country:US
Practice Address - Phone:330-988-6149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148957164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse