Provider Demographics
NPI:1063851699
Name:LARTEY, BENJAMIN ODOI (LPN)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ODOI
Last Name:LARTEY
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 1:1500 SHERWOOD DR APT 1M
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4161
Mailing Address - Country:US
Mailing Address - Phone:513-829-1195
Mailing Address - Fax:
Practice Address - Street 1:1500 SHERWOOD DR APT 1M
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4161
Practice Address - Country:US
Practice Address - Phone:513-829-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 138024164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse