Provider Demographics
NPI:1578602868
Name:MAY, JENNIFER J (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:MAY
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 1:6234 MELSHORE DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-2342
Mailing Address - Country:US
Mailing Address - Phone:440-209-8513
Mailing Address - Fax:
Practice Address - Street 1:6234 MELSHORE DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-2342
Practice Address - Country:US
Practice Address - Phone:440-209-8513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN087775164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2194763Medicaid