Provider Demographics
NPI:1639336829
Name:PEQUIGNOT, JENNIFER IRENE (CNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:IRENE
Last Name:PEQUIGNOT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 STATE ROUTE 442
Mailing Address - Street 2:LOT D17
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-1635
Mailing Address - Country:US
Mailing Address - Phone:570-506-0663
Mailing Address - Fax:
Practice Address - Street 1:1635 STATE ROUTE 442
Practice Address - Street 2:LOT D17
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-1635
Practice Address - Country:US
Practice Address - Phone:570-506-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9979387376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide