Provider Demographics
NPI:1164550612
Name:DEBOE, JENNIFER BEATRICE (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BEATRICE
Last Name:DEBOE
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:PO BOX 13952
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-7952
Mailing Address - Country:US
Mailing Address - Phone:614-864-5762
Mailing Address - Fax:
Practice Address - Street 1:4887 CALVIN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2130
Practice Address - Country:US
Practice Address - Phone:614-864-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN099851164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse