Provider Demographics
NPI:1417671793
Name:ANSELL, JENNIFER RENEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENEE
Last Name:ANSELL
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 1:511 BURROUGHS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3389
Mailing Address - Country:US
Mailing Address - Phone:304-285-5500
Mailing Address - Fax:
Practice Address - Street 1:511 BURROUGHS ST STE 101
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3389
Practice Address - Country:US
Practice Address - Phone:304-285-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37683164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse