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1104159862
LORI A PROVENZANO
WILLOUGHBY, OH
NPI
1104159862
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
(Licence: OH RN264203)
Enumeration Date
2009-09-14
Last Update Date
2014-01-29
Business Address
-- LORI A PROVENZANO
5105 SOM CENTER RD
WILLOUGHBY, OH 44094-4203
Phone number: 440-975-4646
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Mailing Address
-- LORI A PROVENZANO
6247 GATEWOOD DR
MENTOR, OH 44060-2147
Phone number:
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