Provider Demographics
NPI:1639682842
Name:HENSLEY, JENNIFER M (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LIVE OAK TRL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-5812
Mailing Address - Country:US
Mailing Address - Phone:406-231-5027
Mailing Address - Fax:
Practice Address - Street 1:24 LIVE OAK TRL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-5812
Practice Address - Country:US
Practice Address - Phone:406-231-5027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269021163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant