Provider Demographics
NPI:1225438575
Name:WILMER, JENNIFER (LPN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:WILMER
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 1:264 W CRAIG HILL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3426
Mailing Address - Country:US
Mailing Address - Phone:585-978-5475
Mailing Address - Fax:
Practice Address - Street 1:264 W CRAIG HILL DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3426
Practice Address - Country:US
Practice Address - Phone:585-978-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308032164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse