Provider Demographics
NPI:1568110245
Name:SAMUELS, ELVINA B (LPN)
Entity Type:Individual
Prefix:
First Name:ELVINA
Middle Name:B
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ELVINA
Other - Middle Name:B
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:62 VESPER ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2975
Mailing Address - Country:US
Mailing Address - Phone:234-226-3838
Mailing Address - Fax:
Practice Address - Street 1:62 VESPER ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2975
Practice Address - Country:US
Practice Address - Phone:234-226-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN129372164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse