Provider Demographics
NPI:1023322484
Name:LINN, JUDY MAY (LPN)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:MAY
Last Name:LINN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:MAY
Other - Last Name:JARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1255 MISSOURI AVE.
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-9381
Mailing Address - Country:US
Mailing Address - Phone:740-777-1442
Mailing Address - Fax:
Practice Address - Street 1:1255 MISSOURI AVE.
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9381
Practice Address - Country:US
Practice Address - Phone:740-777-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH082395164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse