Provider Demographics
NPI:1174847115
Name:HACKWORTH, JAMI LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:LYNN
Last Name:HACKWORTH
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 1:201 PRIVATE ROAD 349 REAR
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-8925
Mailing Address - Country:US
Mailing Address - Phone:740-532-5515
Mailing Address - Fax:
Practice Address - Street 1:201 PRIVATE ROAD 349 REAR
Practice Address - Street 2:
Practice Address - City:PEDRO
Practice Address - State:OH
Practice Address - Zip Code:45659-8925
Practice Address - Country:US
Practice Address - Phone:740-532-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN . 128734164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse