Provider Demographics
NPI:1851607964
Name:CULBERSON, SONYA RENEE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SONYA
Middle Name:RENEE
Last Name:CULBERSON
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 1:8845 EASTLYNN AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-0601
Mailing Address - Country:US
Mailing Address - Phone:330-837-4257
Mailing Address - Fax:
Practice Address - Street 1:8845 EASTLYNN AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-0601
Practice Address - Country:US
Practice Address - Phone:330-837-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 094005164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse