Provider Demographics
NPI:1861775991
Name:CAULTON MALLETTE, CHER LANETTE (LPN)
Entity type:Individual
Prefix:
First Name:CHER
Middle Name:LANETTE
Last Name:CAULTON MALLETTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4000
Mailing Address - Country:US
Mailing Address - Phone:419-932-5216
Mailing Address - Fax:
Practice Address - Street 1:2242 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4627
Practice Address - Country:US
Practice Address - Phone:419-418-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN108524MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse