Provider Demographics
NPI:1417249814
Name:IVERY, GINNEH (LPN)
Entity Type:Individual
Prefix:
First Name:GINNEH
Middle Name:
Last Name:IVERY
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 1:332 PLEASANT MEADOW BLVD
Mailing Address - Street 2:APT D
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4988
Mailing Address - Country:US
Mailing Address - Phone:330-701-1755
Mailing Address - Fax:
Practice Address - Street 1:332 PLEASANT MEADOW BLVD
Practice Address - Street 2:APT D
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4988
Practice Address - Country:US
Practice Address - Phone:330-701-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141224164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse