Provider Demographics
NPI:1124271374
Name:CRAVEN, ANDREA A (LPN IV CERTIFIED)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:A
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:LPN IV CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5931 FOX GLOVE DR
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-9265
Mailing Address - Country:US
Mailing Address - Phone:419-929-9309
Mailing Address - Fax:
Practice Address - Street 1:5931 FOX GLOVE DR
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-9265
Practice Address - Country:US
Practice Address - Phone:419-929-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN103717164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse