Provider Demographics
NPI:1902217367
Name:GATOR, LOLITA (STNA)
Entity Type:Individual
Prefix:
First Name:LOLITA
Middle Name:
Last Name:GATOR
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 GLENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2428
Mailing Address - Country:US
Mailing Address - Phone:216-526-9556
Mailing Address - Fax:
Practice Address - Street 1:2150 GLENRIDGE RD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2428
Practice Address - Country:US
Practice Address - Phone:216-526-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4014684312123747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant