Provider Demographics
NPI:1164854071
Name:SPRADLING, JENNI ELAN (STNA)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:ELAN
Last Name:SPRADLING
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-3202
Mailing Address - Country:US
Mailing Address - Phone:419-563-9603
Mailing Address - Fax:
Practice Address - Street 1:1021 S EAST ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-3202
Practice Address - Country:US
Practice Address - Phone:419-563-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400388650704376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide