Provider Demographics
NPI:1851670699
Name:SPATES, ELIZABETH CHRISTINA (LPN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTINA
Last Name:SPATES
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 1:2255 PAR LN
Mailing Address - Street 2:602
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-2922
Mailing Address - Country:US
Mailing Address - Phone:440-429-6987
Mailing Address - Fax:
Practice Address - Street 1:2255 PAR LN
Practice Address - Street 2:602
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-2922
Practice Address - Country:US
Practice Address - Phone:440-429-6987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143578164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse