Provider Demographics
NPI:1811186877
Name:HARTUNG, LERYN RAE (LPN)
Entity Type:Individual
Prefix:
First Name:LERYN
Middle Name:RAE
Last Name:HARTUNG
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 1:3272 JESSUP RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6213
Mailing Address - Country:US
Mailing Address - Phone:513-470-2440
Mailing Address - Fax:
Practice Address - Street 1:3272 JESSUP RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6213
Practice Address - Country:US
Practice Address - Phone:513-470-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 123253164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH123253OtherPN LICENSE