Provider Demographics
NPI:1316080005
Name:DAVY, LINDA SUE (LPN)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE
Last Name:DAVY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:SUE
Other - Last Name:DAVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5104 COUNTY ROAD 31
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-9057
Mailing Address - Country:US
Mailing Address - Phone:419-462-5246
Mailing Address - Fax:419-462-5246
Practice Address - Street 1:5104 COUNTY ROAD 31
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-9057
Practice Address - Country:US
Practice Address - Phone:419-462-5246
Practice Address - Fax:419-462-5246
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH115608164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2636786Medicaid