Provider Demographics
NPI:1437752573
Name:HERMILLER, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HERMILLER
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 1:307 EAKIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830-1308
Mailing Address - Country:US
Mailing Address - Phone:419-615-5775
Mailing Address - Fax:
Practice Address - Street 1:307 EAKIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS GROVE
Practice Address - State:OH
Practice Address - Zip Code:45830-1308
Practice Address - Country:US
Practice Address - Phone:419-615-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant