Provider Demographics
NPI:1275064164
Name:ESTES, MISTY RENEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:RENEE
Last Name:ESTES
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 1:798 CARRIAGE HILL LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-3811
Mailing Address - Country:US
Mailing Address - Phone:513-673-6753
Mailing Address - Fax:513-738-7601
Practice Address - Street 1:798 CARRIAGE HILL LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-3811
Practice Address - Country:US
Practice Address - Phone:513-673-6753
Practice Address - Fax:513-738-7601
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-101171-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse