Provider Demographics
NPI:1356659148
Name:PRAITHER, JIMEL JO (LPN)
Entity Type:Individual
Prefix:
First Name:JIMEL
Middle Name:JO
Last Name:PRAITHER
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 1:1706 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4110
Mailing Address - Country:US
Mailing Address - Phone:740-689-1127
Mailing Address - Fax:
Practice Address - Street 1:1706 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4110
Practice Address - Country:US
Practice Address - Phone:740-689-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 132762164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse