Provider Demographics
NPI:1679693287
Name:FOX, LINDA MAE (LPN)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MAE
Last Name:FOX
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 1:14578 BAIRD RD
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-9668
Mailing Address - Country:US
Mailing Address - Phone:440-774-3703
Mailing Address - Fax:440-774-3513
Practice Address - Street 1:14578 BAIRD RD
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-9668
Practice Address - Country:US
Practice Address - Phone:440-774-3703
Practice Address - Fax:440-774-3513
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 055948164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2123955Medicaid