Provider Demographics
NPI:1982836649
Name:STORY, JUDY MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:MARIE
Last Name:STORY
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 1:1848 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-2115
Mailing Address - Country:US
Mailing Address - Phone:715-735-0542
Mailing Address - Fax:
Practice Address - Street 1:1848 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-2115
Practice Address - Country:US
Practice Address - Phone:715-735-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703101878164W00000X
WI308726-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse