Provider Demographics
NPI:1295325124
Name:EVERHART-PROFITT, LORENA
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:EVERHART-PROFITT
Suffix:
Gender:F
Credentials:
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 376
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:OH
Mailing Address - Zip Code:43804-0376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51615 TOWNSHIP ROAD 224
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:OH
Practice Address - Zip Code:43824-9028
Practice Address - Country:US
Practice Address - Phone:740-545-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0243786374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide