Provider Demographics
NPI:1194903617
Name:RATCLIFFE, MARY M (LPN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:RATCLIFFE
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 1:428 6TH ST
Mailing Address - Street 2:APT. DOWN
Mailing Address - City:FAIRPORT HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:44077-5653
Mailing Address - Country:US
Mailing Address - Phone:440-832-7161
Mailing Address - Fax:
Practice Address - Street 1:428 6TH ST
Practice Address - Street 2:APT. DOWN
Practice Address - City:FAIRPORT HARBOR
Practice Address - State:OH
Practice Address - Zip Code:44077-5653
Practice Address - Country:US
Practice Address - Phone:440-832-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 114883164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse