Provider Demographics
NPI:1659697423
Name:HALLOWELL, JEREMIAH JEFF (LPN-IV)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:JEFF
Last Name:HALLOWELL
Suffix:
Gender:M
Credentials:LPN-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WINNER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1954
Mailing Address - Country:US
Mailing Address - Phone:614-716-8861
Mailing Address - Fax:
Practice Address - Street 1:42 WINNER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1954
Practice Address - Country:US
Practice Address - Phone:614-716-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.134796-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse