Provider Demographics
NPI:1932424124
Name:LONG, JUDY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:LONG
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 1:4314 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1835
Mailing Address - Country:US
Mailing Address - Phone:740-407-6045
Mailing Address - Fax:614-725-1509
Practice Address - Street 1:4314 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-1835
Practice Address - Country:US
Practice Address - Phone:740-407-6045
Practice Address - Fax:614-725-1509
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 095460 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse