Provider Demographics
NPI:1952857427
Name:WALLACE, YVONNE SUE (LPN)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:SUE
Last Name:WALLACE
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 1:551 CINCINNATI BATAVIA PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244
Mailing Address - Country:US
Mailing Address - Phone:513-752-1555
Mailing Address - Fax:513-753-2144
Practice Address - Street 1:551 CINCINNATI BATAVIA PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244
Practice Address - Country:US
Practice Address - Phone:513-752-1555
Practice Address - Fax:513-753-2144
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN084503164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse