Provider Demographics
NPI:1154643757
Name:METCALF, DARNETTA (LPN)
Entity Type:Individual
Prefix:MS
First Name:DARNETTA
Middle Name:
Last Name:METCALF
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 1:4515 ALLISON ST
Mailing Address - Street 2:BOX 12087
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2601
Mailing Address - Country:US
Mailing Address - Phone:513-526-9377
Mailing Address - Fax:
Practice Address - Street 1:4515 ALLISON ST
Practice Address - Street 2:BOX 12087
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2601
Practice Address - Country:US
Practice Address - Phone:513-526-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN116034164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3034942Medicaid