Provider Demographics
NPI:1417492646
Name:VINCENT, PATRICE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:PATRICE
Middle Name:
Last Name:VINCENT
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 1:1146 JEANIE J AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2708
Mailing Address - Country:US
Mailing Address - Phone:330-612-2147
Mailing Address - Fax:
Practice Address - Street 1:2112 CASE PKWY
Practice Address - Street 2:UNIT 10
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-4301
Practice Address - Country:US
Practice Address - Phone:330-425-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-25
Last Update Date:2016-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH149019-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH149019-M-IVOtherLPN NURSE LICENSE