Provider Demographics
NPI:1972640357
Name:SHAVER, LORNA LEANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:LEANN
Last Name:SHAVER
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 1:9990 STATE ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:OH
Mailing Address - Zip Code:43758-9528
Mailing Address - Country:US
Mailing Address - Phone:740-342-5417
Mailing Address - Fax:
Practice Address - Street 1:9990 STATE ROUTE 37
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:OH
Practice Address - Zip Code:43758-9528
Practice Address - Country:US
Practice Address - Phone:740-342-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 080309164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2181848Medicaid