Provider Demographics
NPI:1326378274
Name:GRATE, JACQUELYN ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:ANN
Last Name:GRATE
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 1:406 GRATE ROAD
Mailing Address - Street 2:
Mailing Address - City:PATRIOT
Mailing Address - State:OH
Mailing Address - Zip Code:45658
Mailing Address - Country:US
Mailing Address - Phone:740-379-2196
Mailing Address - Fax:
Practice Address - Street 1:406 GRATE RD
Practice Address - Street 2:
Practice Address - City:PATRIOT
Practice Address - State:OH
Practice Address - Zip Code:45658-9178
Practice Address - Country:US
Practice Address - Phone:740-379-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111599164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse