Provider Demographics
NPI:1194183301
Name:CRADLEBAUGH, JOYANNE Y (LPN)
Entity Type:Individual
Prefix:
First Name:JOYANNE
Middle Name:Y
Last Name:CRADLEBAUGH
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 1:201 MADRU ROAD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:OH
Mailing Address - Zip Code:45647
Mailing Address - Country:US
Mailing Address - Phone:740-656-2733
Mailing Address - Fax:
Practice Address - Street 1:201 MADRU RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:OH
Practice Address - Zip Code:45647-9716
Practice Address - Country:US
Practice Address - Phone:740-656-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse