Provider Demographics
NPI:1568680387
Name:NADAL, JENNIFER J (LPN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:J
Last Name:NADAL
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 1:102A AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1705
Mailing Address - Country:US
Mailing Address - Phone:732-309-1622
Mailing Address - Fax:
Practice Address - Street 1:102A AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1705
Practice Address - Country:US
Practice Address - Phone:732-309-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05676200164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse