Provider Demographics
NPI:1922677269
Name:LANDES, JENA NICOLE (CPM)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:NICOLE
Last Name:LANDES
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 BEACHY RD NW
Mailing Address - Street 2:
Mailing Address - City:SUGARCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44681-8103
Mailing Address - Country:US
Mailing Address - Phone:937-564-4903
Mailing Address - Fax:
Practice Address - Street 1:2040 BEACHY RD NW
Practice Address - Street 2:
Practice Address - City:SUGARCREEK
Practice Address - State:OH
Practice Address - Zip Code:44681-8103
Practice Address - Country:US
Practice Address - Phone:937-564-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225Other1225