Provider Demographics
NPI:1811503758
Name:POUPARD, LYNDA
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:POUPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12447 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:OH
Mailing Address - Zip Code:43522-9604
Mailing Address - Country:US
Mailing Address - Phone:419-654-7070
Mailing Address - Fax:
Practice Address - Street 1:12447 S RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:OH
Practice Address - Zip Code:43522-9604
Practice Address - Country:US
Practice Address - Phone:419-654-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant