Provider Demographics
NPI:1407282569
Name:WANJIRU, JEN NYAKIO
Entity Type:Individual
Prefix:
First Name:JEN
Middle Name:NYAKIO
Last Name:WANJIRU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BANNOCK DR
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-5079
Mailing Address - Country:US
Mailing Address - Phone:513-328-8270
Mailing Address - Fax:
Practice Address - Street 1:107 BANNOCK DR
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-5079
Practice Address - Country:US
Practice Address - Phone:513-328-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH321074570808376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide