Provider Demographics
NPI:1780468728
Name:BASTIEN, MYRIAM DESCOLLINES (LPN)
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:DESCOLLINES
Last Name:BASTIEN
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 1:205 ELLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-7520
Mailing Address - Country:US
Mailing Address - Phone:614-377-3099
Mailing Address - Fax:
Practice Address - Street 1:205 ELLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-7520
Practice Address - Country:US
Practice Address - Phone:614-377-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.168229.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse