Provider Demographics
NPI:1295061091
Name:SPATES, ANTONESE RENEE (LPN)
Entity type:Individual
Prefix:MS
First Name:ANTONESE
Middle Name:RENEE
Last Name:SPATES
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 1:3176 AUDUBON BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-5364
Mailing Address - Country:US
Mailing Address - Phone:216-210-7205
Mailing Address - Fax:
Practice Address - Street 1:3176 AUDUBON BOULEVARD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104
Practice Address - Country:US
Practice Address - Phone:216-210-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN122008164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse