Provider Demographics
NPI:1679633416
Name:WILLIAMS, JAN M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JEANNETTE
Other - Middle Name:MAE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:THURSTON
Mailing Address - State:OH
Mailing Address - Zip Code:43157-0343
Mailing Address - Country:US
Mailing Address - Phone:740-862-0848
Mailing Address - Fax:
Practice Address - Street 1:7943 MOLINE DR.
Practice Address - Street 2:
Practice Address - City:THURSTON
Practice Address - State:OH
Practice Address - Zip Code:43157-0343
Practice Address - Country:US
Practice Address - Phone:740-862-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 082802164W00000X
OHPN082802164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2143979OtherODJFS IP #