Provider Demographics
NPI:1457660276
Name:PELCHA, MABELYN RAY (LPN)
Entity Type:Individual
Prefix:
First Name:MABELYN
Middle Name:RAY
Last Name:PELCHA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MABELYN
Other - Middle Name:KAY
Other - Last Name:RAYFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:7542 BRIDGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-2015
Mailing Address - Country:US
Mailing Address - Phone:513-205-3364
Mailing Address - Fax:
Practice Address - Street 1:7542 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-2015
Practice Address - Country:US
Practice Address - Phone:513-205-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN085217164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse