Provider Demographics
NPI:1720719115
Name:LITHERLAND, GWYNDA SUE (LPN)
Entity Type:Individual
Prefix:
First Name:GWYNDA
Middle Name:SUE
Last Name:LITHERLAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:GWYNDA
Other - Middle Name:SUE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:6778 SILVERPOINT RD
Mailing Address - Street 2:
Mailing Address - City:CANNELTON
Mailing Address - State:IN
Mailing Address - Zip Code:47520-6746
Mailing Address - Country:US
Mailing Address - Phone:812-719-9406
Mailing Address - Fax:
Practice Address - Street 1:1143 23RD ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2562
Practice Address - Country:US
Practice Address - Phone:812-547-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27031642C364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care