Provider Demographics
NPI:1417903055
Name:GRATE, CAROLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:GRATE
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 1:1416 BETHLEHEM RD W
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:OH
Mailing Address - Zip Code:43342-9765
Mailing Address - Country:US
Mailing Address - Phone:740-360-2541
Mailing Address - Fax:
Practice Address - Street 1:1416 BETHLEHEM RD W
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:OH
Practice Address - Zip Code:43342-9765
Practice Address - Country:US
Practice Address - Phone:740-360-2541
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN090456164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2229350Medicaid