Provider Demographics
NPI:1871696120
Name:LOYD, GWYNDOLEN ANN (LPN)
Entity type:Individual
Prefix:
First Name:GWYNDOLEN
Middle Name:ANN
Last Name:LOYD
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:RT. 1 BOX 16
Mailing Address - Street 2:
Mailing Address - City:BUNKER
Mailing Address - State:MO
Mailing Address - Zip Code:63629
Mailing Address - Country:US
Mailing Address - Phone:573-689-2751
Mailing Address - Fax:
Practice Address - Street 1:205 WALNUT ST.
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:63638-0157
Practice Address - Country:US
Practice Address - Phone:573-663-2525
Practice Address - Fax:573-663-7821
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO038728164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse