Provider Demographics
NPI:1275113821
Name:STEELE, JENNIFER JEAN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:STEELE
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 1:805 N ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3657
Mailing Address - Country:US
Mailing Address - Phone:419-371-9803
Mailing Address - Fax:
Practice Address - Street 1:1536 CRAYTON AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3722
Practice Address - Country:US
Practice Address - Phone:419-371-9803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant