Provider Demographics
NPI:1083852099
Name:GHENT, TIMOTHY EDWARD (LPN)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:GHENT
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 1:791 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2722
Mailing Address - Country:US
Mailing Address - Phone:513-868-8604
Mailing Address - Fax:513-868-8604
Practice Address - Street 1:791 LOUISE AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2722
Practice Address - Country:US
Practice Address - Phone:513-868-8604
Practice Address - Fax:513-868-8604
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN123117164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse