Provider Demographics
NPI:1083944102
Name:KOREEN, KELLY A (LPN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:KOREEN
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 1:2656 EAGLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3448
Mailing Address - Country:US
Mailing Address - Phone:440-417-2877
Mailing Address - Fax:
Practice Address - Street 1:2656 EAGLE POINT DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3448
Practice Address - Country:US
Practice Address - Phone:440-417-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH116388164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse