Provider Demographics
NPI:1215185616
Name:HASKETT, JENNY (RN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:HASKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:HASKETT-CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10130 OWL HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47868
Mailing Address - Country:US
Mailing Address - Phone:765-719-0263
Mailing Address - Fax:
Practice Address - Street 1:1481 WEST 10TH STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-988-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28096426A163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency