Provider Demographics
NPI:1770322505
Name:ETHRIDGE, NADINE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:MARIE
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 1:291 FLAIR VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98266-7046
Mailing Address - Country:US
Mailing Address - Phone:360-599-2015
Mailing Address - Fax:
Practice Address - Street 1:3645 E MCLEOD RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8700
Practice Address - Country:US
Practice Address - Phone:360-676-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60159147164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse