Provider Demographics
NPI:1073392536
Name:NULL, JENNIFER ROSE (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:NULL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2506
Mailing Address - Country:US
Mailing Address - Phone:304-679-6364
Mailing Address - Fax:
Practice Address - Street 1:1237 CIDER MILL RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:OH
Practice Address - Zip Code:45744-7118
Practice Address - Country:US
Practice Address - Phone:304-679-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide