Provider Demographics
NPI:1689016891
Name:ALEXANDER, JACQUELYNNE J (LPN)
Entity Type:Individual
Prefix:
First Name:JACQUELYNNE
Middle Name:J
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 7TH ST SW
Mailing Address - Street 2:APT. B
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1673
Mailing Address - Country:US
Mailing Address - Phone:330-354-9236
Mailing Address - Fax:
Practice Address - Street 1:3029 7TH ST SW
Practice Address - Street 2:APT. B
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1673
Practice Address - Country:US
Practice Address - Phone:330-354-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN101290164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse