Provider Demographics
NPI:1821279555
Name:USHER, CARMELLA COLSTON (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CARMELLA
Middle Name:COLSTON
Last Name:USHER
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:PO BOX 18981
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-0981
Mailing Address - Country:US
Mailing Address - Phone:216-262-5176
Mailing Address - Fax:216-381-9796
Practice Address - Street 1:1042 HILLSTONE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2426
Practice Address - Country:US
Practice Address - Phone:216-291-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-22
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 062952164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2356589Medicaid