Provider Demographics
NPI:1497405591
Name:LOUDERMILK, ALI GRACE
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:GRACE
Last Name:LOUDERMILK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 HOUFNAGGLE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9450
Mailing Address - Country:US
Mailing Address - Phone:304-647-0774
Mailing Address - Fax:
Practice Address - Street 1:440 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-5169
Practice Address - Country:US
Practice Address - Phone:304-646-7648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty