Provider Demographics
NPI:1346676608
Name:STROH, JENNIFER S (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:STROH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:SETCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2929 MCDOUGALL AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-7410
Mailing Address - Country:US
Mailing Address - Phone:360-802-7558
Mailing Address - Fax:
Practice Address - Street 1:2929 MCDOUGALL AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-7410
Practice Address - Country:US
Practice Address - Phone:360-802-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00052915164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse