Provider Demographics
NPI:1538210117
Name:FOXX, LETRICE DANIELLE (PLN)
Entity type:Individual
Prefix:MRS
First Name:LETRICE
Middle Name:DANIELLE
Last Name:FOXX
Suffix:
Gender:F
Credentials:PLN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4498 STONECASTLE DR. #211
Mailing Address - Street 2:211
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440
Mailing Address - Country:US
Mailing Address - Phone:937-219-8145
Mailing Address - Fax:
Practice Address - Street 1:4498 STONECASTLE DR
Practice Address - Street 2:211
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-3191
Practice Address - Country:US
Practice Address - Phone:937-219-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH115340164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2576190 115340Medicaid