Provider Demographics
NPI:1649417254
Name:CARR, JENNY SUE (RN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:SUE
Last Name:CARR
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 1:65 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:OH
Mailing Address - Zip Code:44822
Mailing Address - Country:US
Mailing Address - Phone:419-571-1993
Mailing Address - Fax:419-688-4005
Practice Address - Street 1:65 HIGH STREET
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:OH
Practice Address - Zip Code:44822
Practice Address - Country:US
Practice Address - Phone:419-571-1993
Practice Address - Fax:419-688-4005
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 323061163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse