Provider Demographics
NPI:1508668047
Name:LADUKE, LILLIAN BRADY (RN)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:BRADY
Last Name:LADUKE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:TAYLOR
Other - Last Name:PHILPOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4610 COOKEVILLE BOAT DOCK RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:TN
Mailing Address - Zip Code:38544-4912
Mailing Address - Country:US
Mailing Address - Phone:931-260-6449
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4294
Practice Address - Country:US
Practice Address - Phone:931-528-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN269746163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse