Provider Demographics
NPI:1386062883
Name:VINCENT-EUGENE, MARIE ANDREE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ANDREE
Last Name:VINCENT-EUGENE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:ANDREE
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:308 SHILOH SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3129
Mailing Address - Country:US
Mailing Address - Phone:937-301-3747
Mailing Address - Fax:
Practice Address - Street 1:308 SHILOH SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3129
Practice Address - Country:US
Practice Address - Phone:937-301-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.124389-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse