Individual
STATHIA LINEBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
602 WOODBRIDGE AVE, LOGANSPORT, IN 46947-1661
(574) 753-3223
(574) 722-9097
Mailing address
2904 S US HIGHWAY 35 LOT 21, LOGANSPORT, IN 46947-6695
(574) 336-2384
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27072417A
IN
Other
Enumeration date
05/06/2022
Last updated
05/06/2022
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