Provider Demographics
NPI:1912031063
Name:VAN HOOSE, LONA M (STNA)
Entity Type:Individual
Prefix:
First Name:LONA
Middle Name:M
Last Name:VAN HOOSE
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 1:106 TRUMAN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2236
Mailing Address - Country:US
Mailing Address - Phone:937-397-5500
Mailing Address - Fax:
Practice Address - Street 1:730 SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-2535
Practice Address - Country:US
Practice Address - Phone:937-236-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH501023500905374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2621667Medicaid