Provider Demographics
NPI:1033650247
Name:DANISON, JERI (LPN)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:DANISON
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 1:2825 TOWNSHIP ROAD 76 NW
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783-9714
Mailing Address - Country:US
Mailing Address - Phone:740-252-2670
Mailing Address - Fax:
Practice Address - Street 1:2825 TOWNSHIP ROAD 76 NW
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:OH
Practice Address - Zip Code:43783-9714
Practice Address - Country:US
Practice Address - Phone:740-252-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.089419.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse