Provider Demographics
NPI:1639495427
Name:CROOK, PAMELA ELAYNE (LPN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELAYNE
Last Name:CROOK
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 1:1714 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3057
Mailing Address - Country:US
Mailing Address - Phone:440-308-1169
Mailing Address - Fax:
Practice Address - Street 1:1714 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3057
Practice Address - Country:US
Practice Address - Phone:440-308-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 123395-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse