Provider Demographics
NPI:1689157570
Name:DOUGLAS, JENNIFER JOY (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOY
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JOY
Other - Last Name:COPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:935 PYRAMID HILL BLVD APT 3B
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-6420
Mailing Address - Country:US
Mailing Address - Phone:513-439-0300
Mailing Address - Fax:
Practice Address - Street 1:935 PYRAMID HILL BLVD APT 3B
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6420
Practice Address - Country:US
Practice Address - Phone:513-439-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH82-1512550251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health