Provider Demographics
NPI:1043711310
Name:PELLEGRINO, JERRIE L (RN, BS)
Entity Type:Individual
Prefix:MRS
First Name:JERRIE
Middle Name:L
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:RN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 CAPTAINS BRG
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-5709
Mailing Address - Country:US
Mailing Address - Phone:513-407-0027
Mailing Address - Fax:
Practice Address - Street 1:532 MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-559-2933
Practice Address - Fax:513-559-2973
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN2627779163WP0807X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent