Provider Demographics
NPI:1851582589
Name:GENTLE, HEATHER ANN (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:GENTLE
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 1:674 HILLGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1608
Mailing Address - Country:US
Mailing Address - Phone:419-606-2221
Mailing Address - Fax:
Practice Address - Street 1:674 HILLGROVE AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1608
Practice Address - Country:US
Practice Address - Phone:419-606-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 118340 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse