Provider Demographics
NPI:1477867521
Name:OUSLEY, DORENDA (LPN)
Entity Type:Individual
Prefix:
First Name:DORENDA
Middle Name:
Last Name:OUSLEY
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 1:27400 CHARDON RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2901
Mailing Address - Country:US
Mailing Address - Phone:216-577-2803
Mailing Address - Fax:
Practice Address - Street 1:27400 CHARDON RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44092-2901
Practice Address - Country:US
Practice Address - Phone:216-877-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-31
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH118592164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse