Provider Demographics
NPI:1831381607
Name:MOILANEN, JUDY LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LYNN
Last Name:MOILANEN
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 1:55794 SALO RD
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-9627
Mailing Address - Country:US
Mailing Address - Phone:906-482-8708
Mailing Address - Fax:
Practice Address - Street 1:55794 SALO RD
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-9627
Practice Address - Country:US
Practice Address - Phone:906-482-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703033239164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse