Provider Demographics
NPI:1053650580
Name:RAAB, NICOLE KATHERINE (LPN-127523)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KATHERINE
Last Name:RAAB
Suffix:
Gender:F
Credentials:LPN-127523
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 FACTORY ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44050-9639
Mailing Address - Country:US
Mailing Address - Phone:440-355-4573
Mailing Address - Fax:
Practice Address - Street 1:202 FACTORY ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:OH
Practice Address - Zip Code:44050-9639
Practice Address - Country:US
Practice Address - Phone:440-355-4573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH127523164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse