Individual
ELLEN ANN BIBEAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
35000 KAISER CT, WILLOUGHBY, OH 44094-3382
(440) 269-4600
Mailing address
35000 KAISER CT, WILLOUGHBY, OH 44094-3382
(440) 269-4600
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
117789
OH
Other
Enumeration date
12/21/2022
Last updated
12/21/2022
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