Provider Demographics
NPI:1417256066
Name:MACKEDANZ, JANE ELLEN (LPN)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELLEN
Last Name:MACKEDANZ
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 1:200 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-7208
Mailing Address - Country:US
Mailing Address - Phone:419-581-2432
Mailing Address - Fax:
Practice Address - Street 1:200 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-7208
Practice Address - Country:US
Practice Address - Phone:419-581-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN099975164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse