Provider Demographics
NPI:1417124710
Name:BAGNALL, JILL M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:M
Last Name:BAGNALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:BOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:201 REDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1453
Mailing Address - Country:US
Mailing Address - Phone:330-242-6923
Mailing Address - Fax:
Practice Address - Street 1:201 REDFIELD ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-1453
Practice Address - Country:US
Practice Address - Phone:330-242-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-107742164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse