Provider Demographics
NPI:1184991747
Name:NETHERY, EDWIN SCOTT (LPN)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:SCOTT
Last Name:NETHERY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2953 ROCKEFELLER RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1425
Mailing Address - Country:US
Mailing Address - Phone:440-836-2532
Mailing Address - Fax:
Practice Address - Street 1:2953 ROCKEFELLER RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44092-1425
Practice Address - Country:US
Practice Address - Phone:440-836-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH124528164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse