Provider Demographics
NPI:1255477741
Name:ISHAM, JANET ELDRIDGE (LPN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ELDRIDGE
Last Name:ISHAM
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 1:1362 N. GATEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854
Mailing Address - Country:US
Mailing Address - Phone:865-354-1220
Mailing Address - Fax:865-354-0112
Practice Address - Street 1:1362 N. GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854
Practice Address - Country:US
Practice Address - Phone:865-354-1220
Practice Address - Fax:865-354-0112
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000025757164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse