Provider Demographics
NPI:1689797789
Name:STONE, YOLANDA NICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:NICHELLE
Last Name:STONE
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 1:1130 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-4622
Mailing Address - Country:US
Mailing Address - Phone:440-246-0132
Mailing Address - Fax:
Practice Address - Street 1:1130 W 24TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-4622
Practice Address - Country:US
Practice Address - Phone:440-246-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN093590164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2295565Medicaid