Provider Demographics
NPI:1932331261
Name:PROFFITT, CAYENNE REGINA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CAYENNE
Middle Name:REGINA
Last Name:PROFFITT
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 1:1825 ADAMS LN APT 108
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2679
Mailing Address - Country:US
Mailing Address - Phone:740-704-4651
Mailing Address - Fax:
Practice Address - Street 1:1825 ADAMS LN APT 108
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2679
Practice Address - Country:US
Practice Address - Phone:740-704-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN . 131791164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse