Provider Demographics
NPI:1669773933
Name:JOSEPH, THERESA MARY (LPN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARY
Last Name:JOSEPH
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 1:52 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-1122
Mailing Address - Country:US
Mailing Address - Phone:419-663-1155
Mailing Address - Fax:
Practice Address - Street 1:52 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1122
Practice Address - Country:US
Practice Address - Phone:419-663-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.095704-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse