Provider Demographics
NPI:1417104472
Name:SMUCKER, JENNIFER R (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:SMUCKER
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 1:584 SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-9564
Mailing Address - Country:US
Mailing Address - Phone:717-354-4711
Mailing Address - Fax:717-354-0824
Practice Address - Street 1:584 SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-9564
Practice Address - Country:US
Practice Address - Phone:717-354-4711
Practice Address - Fax:717-354-0824
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN270632164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPN270632OtherLICENSE NUMBER