Individual
DAWNETTECOULBOURNE L COULBOURNE I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4575 HAYES RD, RAVENNA, OH 44266-3711
(330) 931-2067
Mailing address
4575 HAYES RD, RAVENNA, OH 44266-3711
(330) 931-2067
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
060689
OH
Other
Enumeration date
04/27/2014
Last updated
04/27/2014
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