Stathia Lineback, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

27072417A Issued in IN

Practice address

602 Woodbridge Ave
Logansport, IN 46947-1661

Phone

(574) 753-3223

Fax

(574) 722-9097

NPI assigned

May 6, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1902542681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2904 S US HIGHWAY 35 LOT 21",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469476695",
            "telephone_number": "574-336-2384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 WOODBRIDGE AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471661",
            "telephone_number": "574-753-3223",
            "fax_number": "574-722-9097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINEBACK",
        "first_name": "STATHIA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-06",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IN",
            "license": "27072417A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Logansport, IN
• Providers in Logansport, IN by specialty
• Licensed Practical Nurse in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.