Provider Demographics
NPI:1457755829
Name:DEAN, PATRINA ELAINE (LPN M-IV)
Entity Type:Individual
Prefix:
First Name:PATRINA
Middle Name:ELAINE
Last Name:DEAN
Suffix:
Gender:F
Credentials:LPN M-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 PROSPERITY PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-4028
Mailing Address - Country:US
Mailing Address - Phone:513-302-4006
Mailing Address - Fax:
Practice Address - Street 1:4802 PROSPERITY PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-4028
Practice Address - Country:US
Practice Address - Phone:513-302-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN156387 M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse