Provider Demographics
NPI:1639573983
Name:HENNIES, JANE (RN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HENNIES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3179 KENNEDY FORD RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-8336
Mailing Address - Country:US
Mailing Address - Phone:513-734-1425
Mailing Address - Fax:
Practice Address - Street 1:3179 KENNEDY FORD RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-8336
Practice Address - Country:US
Practice Address - Phone:513-734-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.18446163W00000X, 163WG0600X
OHRN.184466163WH0200X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics