Provider Demographics
NPI:1003218157
Name:JENNE, KRISTINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:JENNE
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 1:164 HANNUM AVE
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1110
Mailing Address - Country:US
Mailing Address - Phone:419-377-0045
Mailing Address - Fax:
Practice Address - Street 1:164 HANNUM AVE
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1110
Practice Address - Country:US
Practice Address - Phone:419-377-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-062301164W00000X
MI4703088946164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse