Individual
MRS. CHYVON NICHOLE CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1021 W 51ST ST, ASHTABULA, OH 44004-6725
(440) 650-4904
Mailing address
1021 W 51ST ST, ASHTABULA, OH 44004-6725
(440) 650-4904
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
158104
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPN 158104 M-IV
OHIO BOARD OF NURSING LICENSE NUMBER
OH
Enumeration date
11/28/2016
Last updated
11/28/2016
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