Provider Demographics
NPI:1184231904
Name:PRUDEN, JENA C
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:C
Last Name:PRUDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5494 BULLFINCH DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8606
Mailing Address - Country:US
Mailing Address - Phone:419-217-4314
Mailing Address - Fax:
Practice Address - Street 1:5494 BULLFINCH DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8606
Practice Address - Country:US
Practice Address - Phone:419-217-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2570141Medicaid