Provider Demographics
NPI:1760750905
Name:CONTRERAS, JENNIFER LIZZETTE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LIZZETTE
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2907
Mailing Address - Country:US
Mailing Address - Phone:440-452-6065
Mailing Address - Fax:
Practice Address - Street 1:425 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2907
Practice Address - Country:US
Practice Address - Phone:440-452-6065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401314341011376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401314341011OtherOHIO NURSE AIDE REGISTRY