Provider Demographics
NPI:1275063646
Name:TROUTMAN, EDWARD (LPN)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TROUTMAN
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:PO BOX 20068
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43610-0068
Mailing Address - Country:US
Mailing Address - Phone:419-531-5544
Mailing Address - Fax:
Practice Address - Street 1:5301 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-4632
Practice Address - Country:US
Practice Address - Phone:419-531-5544
Practice Address - Fax:419-531-5117
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.077475.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2901122Medicaid