Provider Demographics
NPI:1235562802
Name:PRATT, CONNIE SUE (LPN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:PRATT
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 1:5035 TOWNSHIP ROAD 99
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43324-9686
Mailing Address - Country:US
Mailing Address - Phone:352-250-2364
Mailing Address - Fax:
Practice Address - Street 1:5035 TOWNSHIP ROAD 99
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43324-9686
Practice Address - Country:US
Practice Address - Phone:352-250-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.096384-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse