Provider Demographics
NPI:1295036127
Name:MINNICH, JENNIFER S (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:MINNICH
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 1:321 ARMSTRONG ST
Mailing Address - Street 2:PO BOX 222
Mailing Address - City:HALIFAX
Mailing Address - State:PA
Mailing Address - Zip Code:17032
Mailing Address - Country:US
Mailing Address - Phone:717-761-0930
Mailing Address - Fax:717-761-0465
Practice Address - Street 1:423 N 21ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2207
Practice Address - Country:US
Practice Address - Phone:717-761-0930
Practice Address - Fax:717-761-0465
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN275150164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse