Provider Demographics
NPI:1063607612
Name:RUFFIN, LAPETHA MONEK (LPN)
Entity type:Individual
Prefix:MS
First Name:LAPETHA
Middle Name:MONEK
Last Name:RUFFIN
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 1:28899 HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4741
Mailing Address - Country:US
Mailing Address - Phone:216-464-4888
Mailing Address - Fax:
Practice Address - Street 1:28899 HARVARD RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4741
Practice Address - Country:US
Practice Address - Phone:216-464-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH099459164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2667529Medicaid