Provider Demographics
NPI:1154651859
Name:TRAVIS, JENIFER JO (LPN)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:JO
Last Name:TRAVIS
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 1:7412 TOTTENHAM PL
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9443
Mailing Address - Country:US
Mailing Address - Phone:614-448-6059
Mailing Address - Fax:
Practice Address - Street 1:7412 TOTTENHAM PL
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9443
Practice Address - Country:US
Practice Address - Phone:614-448-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134798164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse