Provider Demographics
NPI:1245042076
Name:LANDBACK, JOSEPHINE ANNE (RN)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ANNE
Last Name:LANDBACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E OLDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5561
Mailing Address - Country:US
Mailing Address - Phone:860-389-5466
Mailing Address - Fax:
Practice Address - Street 1:416 E OLDHAM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5561
Practice Address - Country:US
Practice Address - Phone:860-389-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN271062163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical