Basic Information
| Provider Information | |||||||||
| NPI: | 1366744138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LICHTENSTEIN | ||||||||
| FirstName: | SONYA | ||||||||
| MiddleName: | JOLINE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LICHTENSTEIN | ||||||||
| OtherFirstName: | SONYA | ||||||||
| OtherMiddleName: | JOLINE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15 ARLINGTON PL | ||||||||
| Address2: | |||||||||
| City: | FORT THOMAS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410752400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8598164824 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL VILLAGE DR STE 258 | ||||||||
| Address2: | ST. ELIZABETH HOSPITAL | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593417246 | ||||||||
| FaxNumber: | 8593417867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2010 | ||||||||
| LastUpdateDate: | 05/07/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 85927 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | 1118077 | KY | N | Nursing Service Providers | Registered Nurse | 163W00000X | 325071 | OH | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 201009550 | 05 | IN | MEDICAID | 000000698683 | 01 | ANTHEM BLUE CROSS BLUE SHIELD | OTHER | 3137608 | 05 | OH | MEDICAID | 7100149460 | 05 | KY | MEDICAID | 611077369 1295716850 | 01 | HEALTHNET | OTHER |