Provider Demographics
NPI:1134710114
Name:HEARN, ECHO LARIE (LPN)
Entity type:Individual
Prefix:
First Name:ECHO
Middle Name:LARIE
Last Name:HEARN
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 1:14520 MILVERTON RD APT 203
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4187
Mailing Address - Country:US
Mailing Address - Phone:216-450-8280
Mailing Address - Fax:
Practice Address - Street 1:1414 S GREEN RD STE 112
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3936
Practice Address - Country:US
Practice Address - Phone:216-450-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168943164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH168943OtherOHIO BOARD OF NURSING