Provider Demographics
NPI:1851449615
Name:PRINCE, LETISHA ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LETISHA
Middle Name:ANN
Last Name:PRINCE
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 1:2498 KELLOGG RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9783
Mailing Address - Country:US
Mailing Address - Phone:440-315-4381
Mailing Address - Fax:
Practice Address - Street 1:2498 KELLOGG ROAD
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:OH
Practice Address - Zip Code:44233-9692
Practice Address - Country:US
Practice Address - Phone:440-315-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH085204164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2621818Medicare ID - Type Unspecified