Provider Demographics
NPI:1043358849
Name:CUMMINS, TRUDY LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:TRUDY
Middle Name:LYNN
Last Name:CUMMINS
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 1:3621 TWP RD 161
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:OH
Mailing Address - Zip Code:43334
Mailing Address - Country:US
Mailing Address - Phone:419-864-4636
Mailing Address - Fax:
Practice Address - Street 1:3621 TWP RD 161
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:OH
Practice Address - Zip Code:43334
Practice Address - Country:US
Practice Address - Phone:419-864-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN068399164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN068399OtherLICENSE NUMBER