Provider Demographics
NPI:1740586510
Name:MASLANIK, JENNIFER ELAIN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELAIN
Last Name:MASLANIK
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 1:1154 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-1622
Mailing Address - Country:US
Mailing Address - Phone:440-645-6759
Mailing Address - Fax:
Practice Address - Street 1:1154 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-1622
Practice Address - Country:US
Practice Address - Phone:440-645-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.141605-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse