Provider Demographics
NPI:1215128830
Name:SANISLOW-HALL, JUDITH L (LPN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:SANISLOW-HALL
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 1:13445 DIAGONAL RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44050-9723
Mailing Address - Country:US
Mailing Address - Phone:440-225-9843
Mailing Address - Fax:
Practice Address - Street 1:13445 DIAGONAL RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:OH
Practice Address - Zip Code:44050-9723
Practice Address - Country:US
Practice Address - Phone:440-225-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN098305164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse