Provider Demographics
NPI:1083876841
Name:LETOURNEAU, VIDA JOY (LPN)
Entity Type:Individual
Prefix:MS
First Name:VIDA
Middle Name:JOY
Last Name:LETOURNEAU
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 1:347 RAMSEY ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2323
Mailing Address - Country:US
Mailing Address - Phone:651-228-1360
Mailing Address - Fax:
Practice Address - Street 1:347 RAMSEY ST
Practice Address - Street 2:UNIT A
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2323
Practice Address - Country:US
Practice Address - Phone:651-228-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0462745164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse