Provider Demographics
NPI:1235455080
Name:FORESTER, JILL ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:FORESTER
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 1:7170 PIKE TWP RD 219 SE
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764
Mailing Address - Country:US
Mailing Address - Phone:740-605-4232
Mailing Address - Fax:
Practice Address - Street 1:7170 TOWNSHIP ROAD 219
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-9095
Practice Address - Country:US
Practice Address - Phone:740-605-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 126958164W00000X
OHPN126958164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse