Provider Demographics
NPI:1063015881
Name:WINCHENBACH, JESSICA JANE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:WINCHENBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15979 EDGINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-9325
Mailing Address - Country:US
Mailing Address - Phone:513-915-4617
Mailing Address - Fax:
Practice Address - Street 1:15979 EDGINGTON RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-9325
Practice Address - Country:US
Practice Address - Phone:513-915-4617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0801625Medicaid