Provider Demographics
NPI:1760802557
Name:PHILIP, JAIME LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:PHILIP
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 1:459 WATER ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:43734-9754
Mailing Address - Country:US
Mailing Address - Phone:740-624-2428
Mailing Address - Fax:
Practice Address - Street 1:459 WATER ST
Practice Address - Street 2:
Practice Address - City:DUNCAN FALLS
Practice Address - State:OH
Practice Address - Zip Code:43734-9754
Practice Address - Country:US
Practice Address - Phone:740-624-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.136042164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse