Provider Demographics
NPI:1194958181
Name:NORTH, LADEYA LYNN (LPN)
Entity type:Individual
Prefix:MS
First Name:LADEYA
Middle Name:LYNN
Last Name:NORTH
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 1:6408 CLEMATIS DR
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3012
Mailing Address - Country:US
Mailing Address - Phone:937-313-3805
Mailing Address - Fax:937-436-0899
Practice Address - Street 1:6408 CLEMATIS DR
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3012
Practice Address - Country:US
Practice Address - Phone:937-313-3805
Practice Address - Fax:937-436-0899
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133161164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2972985Medicaid