Provider Demographics
NPI:1043594559
Name:NURSING SERVICE LPN
Entity type:Organization
Organization Name:NURSING SERVICE LPN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-494-8634
Mailing Address - Street 1:15815 GORRILL RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9787
Mailing Address - Country:US
Mailing Address - Phone:419-601-5457
Mailing Address - Fax:
Practice Address - Street 1:15815 GORRILL RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9787
Practice Address - Country:US
Practice Address - Phone:419-601-5457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care