Provider Demographics
NPI:1114176310
Name:BERTINO, LUCILLE ANN (RN)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:ANN
Last Name:BERTINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LUCILLE
Other - Middle Name:ANN
Other - Last Name:KEAVENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:54 S STATE ST
Mailing Address - Street 2:RM 204
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3445
Mailing Address - Country:US
Mailing Address - Phone:440-357-6740
Mailing Address - Fax:440-350-0506
Practice Address - Street 1:54 S STATE ST
Practice Address - Street 2:RM 204
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3445
Practice Address - Country:US
Practice Address - Phone:440-357-6740
Practice Address - Fax:440-350-0506
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN109821163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health