Provider Demographics
NPI:1073911806
Name:GILL, JENNIFER LUCILLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LUCILLE
Last Name:GILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-1924
Mailing Address - Country:US
Mailing Address - Phone:740-710-9592
Mailing Address - Fax:
Practice Address - Street 1:504 E 7TH ST
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-1924
Practice Address - Country:US
Practice Address - Phone:740-710-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155450164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse