Provider Demographics
NPI:1851957435
Name:HADLEY, JENNA L (BSN-RN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:HADLEY
Suffix:
Gender:F
Credentials:BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-2804
Mailing Address - Country:US
Mailing Address - Phone:210-422-2155
Mailing Address - Fax:
Practice Address - Street 1:809 W 19TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-2804
Practice Address - Country:US
Practice Address - Phone:210-422-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX966682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse