Provider Demographics
NPI:1952543308
Name:WARE, LAURETTA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:LAURETTA
Middle Name:JEAN
Last Name:WARE
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 1:1380 ARBOR ST. SE APT 508
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4448
Mailing Address - Country:US
Mailing Address - Phone:330-406-0026
Mailing Address - Fax:
Practice Address - Street 1:1380 ARBOR ST. SE APT 508
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4448
Practice Address - Country:US
Practice Address - Phone:330-406-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH043259164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse