Provider Demographics
NPI:1083109169
Name:DRAKE, CIERRA RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:RENEE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 REINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-5604
Mailing Address - Country:US
Mailing Address - Phone:419-944-6936
Mailing Address - Fax:
Practice Address - Street 1:1731 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-5245
Practice Address - Country:US
Practice Address - Phone:419-944-6936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167906164W00000X
OH512034163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse