Provider Demographics
NPI:1659664712
Name:ROE, CYNTHIA M (LPN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:ROE
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 1:1026 SOUR RUN RD
Mailing Address - Street 2:
Mailing Address - City:RAY
Mailing Address - State:OH
Mailing Address - Zip Code:45672-9614
Mailing Address - Country:US
Mailing Address - Phone:740-286-6171
Mailing Address - Fax:740-286-6171
Practice Address - Street 1:1026 SOUR RUN RD
Practice Address - Street 2:
Practice Address - City:RAY
Practice Address - State:OH
Practice Address - Zip Code:45672-9614
Practice Address - Country:US
Practice Address - Phone:740-286-6171
Practice Address - Fax:740-286-6171
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.N. 119839-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse