Provider Demographics
NPI:1619915485
Name:ALLRED, JEANETTE ANN
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:ANN
Last Name:ALLRED
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 1:88825 MILLERS STATION RD
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:OH
Mailing Address - Zip Code:43976-9730
Mailing Address - Country:US
Mailing Address - Phone:740-946-1821
Mailing Address - Fax:
Practice Address - Street 1:88825 MILLERS STATION RD
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:OH
Practice Address - Zip Code:43976-9730
Practice Address - Country:US
Practice Address - Phone:740-946-1821
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2404222Medicaid