Provider Demographics
NPI:1134486343
Name:VINCENT, CAITLIN SUZANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:SUZANNE
Last Name:VINCENT
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 1:5602 WILLOWDALE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8900
Mailing Address - Country:US
Mailing Address - Phone:937-215-5502
Mailing Address - Fax:
Practice Address - Street 1:5602 WILLOWDALE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8900
Practice Address - Country:US
Practice Address - Phone:937-215-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138593-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse