Provider Demographics
NPI:1083996581
Name:WAINAINA, JEMIMAH MUTHONI (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JEMIMAH
Middle Name:MUTHONI
Last Name:WAINAINA
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 1:8202 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-5532
Mailing Address - Country:US
Mailing Address - Phone:614-309-6293
Mailing Address - Fax:
Practice Address - Street 1:8202 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-5532
Practice Address - Country:US
Practice Address - Phone:614-309-6293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN130041101YM0800X, 320900000X
OHPN 130041164W00000X, 164X00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No372600000XNursing Service Related ProvidersAdult Companion