Provider Demographics
NPI:1588808018
Name:NGATIA, PAUL M (LPN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:M
Last Name:NGATIA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 EDDY ST APT D
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5192
Mailing Address - Country:US
Mailing Address - Phone:614-424-1593
Mailing Address - Fax:
Practice Address - Street 1:273 EDDY ST APT D
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5192
Practice Address - Country:US
Practice Address - Phone:614-424-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 120963164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse