Provider Demographics
NPI:1033858949
Name:PUGH, JAYNE ELLEN (LPN)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:ELLEN
Last Name:PUGH
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 1:269 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-8996
Mailing Address - Country:US
Mailing Address - Phone:765-472-8049
Mailing Address - Fax:
Practice Address - Street 1:269 MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-8996
Practice Address - Country:US
Practice Address - Phone:765-472-8049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27053965A364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care