Provider Demographics
NPI:1659619773
Name:ANGEL, JENNIFER BUCKMAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BUCKMAN
Last Name:ANGEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:BUCKMAN
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:86 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:OTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18942-9771
Mailing Address - Country:US
Mailing Address - Phone:610-847-2600
Mailing Address - Fax:
Practice Address - Street 1:86 SHERMAN RD
Practice Address - Street 2:
Practice Address - City:OTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18942-9771
Practice Address - Country:US
Practice Address - Phone:610-847-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN099780L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse