Provider Demographics
NPI:1548402365
Name:KIRBY, MISTY DAWN (LPN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:KIRBY
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 1:500 FURNACE RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-9610
Mailing Address - Country:US
Mailing Address - Phone:440-829-0595
Mailing Address - Fax:
Practice Address - Street 1:500 FURNACE RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-9610
Practice Address - Country:US
Practice Address - Phone:440-829-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 128022164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse