Provider Demographics
NPI:1952884694
Name:CAC, DENNIE (LPN)
Entity Type:Individual
Prefix:
First Name:DENNIE
Middle Name:
Last Name:CAC
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 FAIRBORN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2552
Mailing Address - Country:US
Mailing Address - Phone:513-207-3469
Mailing Address - Fax:
Practice Address - Street 1:795 FAIRBORN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-2552
Practice Address - Country:US
Practice Address - Phone:513-207-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168269164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse