Provider Demographics
NPI:1588791115
Name:LONGMIRE, LUCY MARIE (LPN CERTIFICATION)
Entity type:Individual
Prefix:MS
First Name:LUCY
Middle Name:MARIE
Last Name:LONGMIRE
Suffix:
Gender:F
Credentials:LPN CERTIFICATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SUMMAR DR
Mailing Address - Street 2:CDC CLINIC
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3905
Mailing Address - Country:US
Mailing Address - Phone:731-421-6735
Mailing Address - Fax:731-421-5000
Practice Address - Street 1:295 SUMMAR DR
Practice Address - Street 2:CDC CLINIC
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3905
Practice Address - Country:US
Practice Address - Phone:731-421-6735
Practice Address - Fax:731-421-5000
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000035719164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse