Provider Demographics
NPI:1629388723
Name:MCDERMIT, CHRISTINE NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:MCDERMIT
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 1:5820 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45333-8609
Mailing Address - Country:US
Mailing Address - Phone:937-821-4015
Mailing Address - Fax:
Practice Address - Street 1:5820 SMITH RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:OH
Practice Address - Zip Code:45333-8609
Practice Address - Country:US
Practice Address - Phone:937-821-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-141622-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2455614Medicaid