Provider Demographics
NPI:1306369673
Name:OLA, PREXY SAM (LPN)
Entity Type:Individual
Prefix:MR
First Name:PREXY
Middle Name:SAM
Last Name:OLA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-1167
Mailing Address - Country:US
Mailing Address - Phone:513-413-4396
Mailing Address - Fax:
Practice Address - Street 1:1025 SOUTH FRONT STREET,
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011
Practice Address - Country:US
Practice Address - Phone:513-413-4396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPN151846MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse