Provider Demographics
NPI:1699858423
Name:RARDON, LORIE ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:LORIE
Middle Name:ANN
Last Name:RARDON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LORIE
Other - Middle Name:ANN
Other - Last Name:RARDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:96 W FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1623
Mailing Address - Country:US
Mailing Address - Phone:740-815-5523
Mailing Address - Fax:
Practice Address - Street 1:96 W FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1623
Practice Address - Country:US
Practice Address - Phone:740-815-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN115777164W00000X
OHRN349027163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2532558OtherPROVIDER NUMBER
OHRN 349027OtherOHIO BOARD OF NURSING