Provider Demographics
NPI:1073838645
Name:CLENNEY, JON ERIC (LPN)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:ERIC
Last Name:CLENNEY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:JON
Other - Middle Name:
Other - Last Name:CLENNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:6391 PAYNE RD
Mailing Address - Street 2:
Mailing Address - City:TOBACCOVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27050-9646
Mailing Address - Country:US
Mailing Address - Phone:336-983-5368
Mailing Address - Fax:
Practice Address - Street 1:6391 PAYNE RD
Practice Address - Street 2:
Practice Address - City:TOBACCOVILLE
Practice Address - State:NC
Practice Address - Zip Code:27050-9646
Practice Address - Country:US
Practice Address - Phone:336-983-5368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68908164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse