Provider Demographics
NPI:1295163582
Name:RODDIE, LYCHALE DONEE (LPN)
Entity type:Individual
Prefix:MS
First Name:LYCHALE
Middle Name:DONEE
Last Name:RODDIE
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 1:1485 KNUTH AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3167
Mailing Address - Country:US
Mailing Address - Phone:440-840-1636
Mailing Address - Fax:
Practice Address - Street 1:1485 KNUTH AVE
Practice Address - Street 2:APARTMENT 507
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3167
Practice Address - Country:US
Practice Address - Phone:440-840-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152977164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056667Medicaid