Provider Demographics
NPI:1255529368
Name:DODD, JUDY (LPN)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:DODD
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 1:244 S OLIVE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-2100
Mailing Address - Country:US
Mailing Address - Phone:574-282-3230
Mailing Address - Fax:574-282-3240
Practice Address - Street 1:244 S OLIVE ST
Practice Address - Street 2:SUITE E
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-2100
Practice Address - Country:US
Practice Address - Phone:574-282-3230
Practice Address - Fax:574-282-3240
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27058567A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse