Active NPI
Lonna Marie Clark, LPN
- Licensed Practical Nurse
- Mansfield, OH
National Provider Identifier
1730430307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN054675
- Practice address
- 640 Holiday Dr
Mansfield, OH 44904-1819 - Phone
- (419) 571-2545
- NPI assigned
- Sep 24, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN054675 | OH | Primary |
Addresses
Primary practice location
640 Holiday Dr
Mansfield, OH 44904-1819
Mailing address
640 Holiday Dr
Mansfield, OH 44904-1819
Phone (419) 571-2545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN054675 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348444800000",
"number": "1730430307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "640 HOLIDAY DR",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449041819",
"telephone_number": "419-571-2545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 HOLIDAY DR",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449041819",
"telephone_number": "419-571-2545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LONNA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-24",
"last_updated": "2012-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN054675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.