Provider Demographics
NPI:1124601166
Name:HUDDLESTON, JANET LEE (LPN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LEE
Last Name:HUDDLESTON
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 1:4202 SW LEE BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8300
Mailing Address - Country:US
Mailing Address - Phone:580-771-2662
Mailing Address - Fax:580-771-2660
Practice Address - Street 1:4202 SW LEE BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8300
Practice Address - Country:US
Practice Address - Phone:580-771-2662
Practice Address - Fax:580-771-2660
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0068336164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse