Provider Demographics
NPI:1326856758
Name:UTLEY, LENNITA I
Entity type:Individual
Prefix:
First Name:LENNITA
Middle Name:I
Last Name:UTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-9003
Mailing Address - Country:US
Mailing Address - Phone:216-287-5161
Mailing Address - Fax:
Practice Address - Street 1:689 LOVERS LN
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-1926
Practice Address - Country:US
Practice Address - Phone:216-287-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185090164X00000X
OHSK659497343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No164X00000XNursing Service ProvidersLicensed Vocational Nurse