Provider Demographics
NPI:1609019397
Name:KPANLIN-DEMOLA, LORIE RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:RENEE
Last Name:KPANLIN-DEMOLA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:LORIE
Other - Middle Name:
Other - Last Name:OBASOGIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:24101 LAKE SHORE BLVD
Mailing Address - Street 2:APT 1102A
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1225
Mailing Address - Country:US
Mailing Address - Phone:216-289-0816
Mailing Address - Fax:
Practice Address - Street 1:24101 LAKE SHORE BLVD
Practice Address - Street 2:APT 1102A
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1225
Practice Address - Country:US
Practice Address - Phone:216-289-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-11
Last Update Date:2009-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 086357164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse