Provider Demographics
NPI:1417370669
Name:RAVIZEE, KIMBELY (LPN)
Entity Type:Individual
Prefix:
First Name:KIMBELY
Middle Name:
Last Name:RAVIZEE
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 1:13309 SVEC AVE
Mailing Address - Street 2:UNIT UP
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4723
Mailing Address - Country:US
Mailing Address - Phone:440-241-0825
Mailing Address - Fax:
Practice Address - Street 1:13309 SVEC AVE
Practice Address - Street 2:UNIT UP
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4723
Practice Address - Country:US
Practice Address - Phone:440-241-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN145700164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse