Healthcare Provider Details

I. General information

NPI: 1720719115
Provider Name (Legal Business Name): GWYNDA SUE LITHERLAND LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GWYNDA SUE SMITH LPN

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 23RD ST
TELL CITY IN
47586-2562
US

IV. Provider business mailing address

6778 SILVERPOINT RD
CANNELTON IN
47520-6746
US

V. Phone/Fax

Practice location:
  • Phone: 812-547-2333
  • Fax:
Mailing address:
  • Phone: 812-719-9406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number27031642C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: