Provider Demographics
NPI:1174186423
Name:BENNETT, ISHIKIA CAROLINE (LPN)
Entity Type:Individual
Prefix:
First Name:ISHIKIA
Middle Name:CAROLINE
Last Name:BENNETT
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 1:1358 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1139
Mailing Address - Country:US
Mailing Address - Phone:440-420-3749
Mailing Address - Fax:
Practice Address - Street 1:1358 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1139
Practice Address - Country:US
Practice Address - Phone:440-420-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN158308164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse