Provider Demographics
NPI:1558710657
Name:MEKUS, LORETTA (LPN)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:
Last Name:MEKUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LORETTA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:6624 BIG CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-2814
Mailing Address - Country:US
Mailing Address - Phone:419-685-1857
Mailing Address - Fax:
Practice Address - Street 1:6624 BIG CREEK PKWY
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-2814
Practice Address - Country:US
Practice Address - Phone:419-685-1857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.139502-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse