Provider Demographics
NPI:1376959619
Name:SMITH, JENNIE LYN (RN)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:LYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:LYN
Other - Last Name:SMITH-MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2086
Mailing Address - Country:US
Mailing Address - Phone:507-532-2264
Mailing Address - Fax:507-532-6920
Practice Address - Street 1:1411 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2086
Practice Address - Country:US
Practice Address - Phone:507-532-2264
Practice Address - Fax:507-532-6920
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-190049-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse