Provider Demographics
NPI:1073815189
Name:STRADER, JENNIFER KAY
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAY
Last Name:STRADER
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 1:215 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:OH
Mailing Address - Zip Code:45858
Mailing Address - Country:US
Mailing Address - Phone:419-420-5611
Mailing Address - Fax:
Practice Address - Street 1:215 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:OH
Practice Address - Zip Code:45858
Practice Address - Country:US
Practice Address - Phone:419-420-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide