Provider Demographics
NPI:1356663348
Name:ETHRIDGE, JOY ANN (LPN)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:ANN
Last Name:ETHRIDGE
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 1:6773 OLEANDER CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-8336
Mailing Address - Country:US
Mailing Address - Phone:513-616-0701
Mailing Address - Fax:
Practice Address - Street 1:6773 OLEANDER CT
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-8336
Practice Address - Country:US
Practice Address - Phone:513-616-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 137771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse