Provider Demographics
NPI:1912217704
Name:GREEN, JENNIFER LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 TROY ROAD
Mailing Address - Street 2:
Mailing Address - City:DELWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015
Mailing Address - Country:US
Mailing Address - Phone:740-936-0412
Mailing Address - Fax:740-936-0412
Practice Address - Street 1:2180 TROY ROAD
Practice Address - Street 2:
Practice Address - City:DELWARE
Practice Address - State:OH
Practice Address - Zip Code:43015
Practice Address - Country:US
Practice Address - Phone:740-936-0412
Practice Address - Fax:740-936-0412
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.341832163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse