Provider Demographics
NPI:1396925210
Name:HOWARD, MARY FRANCES (LPN LICENSE PRACTICA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:FRANCES
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LPN LICENSE PRACTICA
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:FRANCES
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN LICNESE PRACTICA
Mailing Address - Street 1:23117 FAIRMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-464-6785
Mailing Address - Fax:
Practice Address - Street 1:1034 RENFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-464-6785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN020290164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2687203Medicaid