Provider Demographics
NPI:1134305659
Name:DAVENPORT, LORRAINE (LPN)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:DAVENPORT
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 1:1059 SEWARD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2627
Mailing Address - Country:US
Mailing Address - Phone:330-836-0384
Mailing Address - Fax:
Practice Address - Street 1:1059 SEWARD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2627
Practice Address - Country:US
Practice Address - Phone:330-836-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH105371164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse