Provider Demographics
NPI:1417765280
Name:SIWAKOTI, PUSPA L (LPN)
Entity type:Individual
Prefix:
First Name:PUSPA
Middle Name:L
Last Name:SIWAKOTI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24865 US HIGHWAY 23 S STE A
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9189
Mailing Address - Country:US
Mailing Address - Phone:614-314-7516
Mailing Address - Fax:
Practice Address - Street 1:24865 US HIGHWAY 23 S STE A
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9189
Practice Address - Country:US
Practice Address - Phone:614-314-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.182184.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse