Provider Demographics
NPI:1528402567
Name:MINNIX, LINDA LOUISE (LPN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOUISE
Last Name:MINNIX
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 1:458 JOHNSON ROAD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601
Mailing Address - Country:US
Mailing Address - Phone:740-775-8389
Mailing Address - Fax:
Practice Address - Street 1:458 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3015
Practice Address - Country:US
Practice Address - Phone:740-775-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN083750164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN083750OtherOHIO BOARD OF NURSING