Provider Demographics
NPI:1871538561
Name:FYFFE, LINDA ANN (LPN)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:FYFFE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:FYFFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:1909 TIMMONDS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3123
Mailing Address - Country:US
Mailing Address - Phone:740-353-7301
Mailing Address - Fax:
Practice Address - Street 1:1909 TIMMONDS AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3123
Practice Address - Country:US
Practice Address - Phone:740-353-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN092051164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2104350Medicaid