Provider Demographics
NPI:1083311070
Name:LAHMAN, NICOLE J
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:J
Last Name:LAHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8928
Mailing Address - Country:US
Mailing Address - Phone:330-274-6270
Mailing Address - Fax:
Practice Address - Street 1:2815 LOVERS LN
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-8928
Practice Address - Country:US
Practice Address - Phone:330-274-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3186Medicaid
OH9804Medicaid
OH1006Medicaid