Provider Demographics
NPI:1942697982
Name:WINE, JALYN YVETTE (STNA)
Entity Type:Individual
Prefix:
First Name:JALYN
Middle Name:YVETTE
Last Name:WINE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CANDLEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-9661
Mailing Address - Country:US
Mailing Address - Phone:419-953-9518
Mailing Address - Fax:
Practice Address - Street 1:227 CANDLEWOOD PL
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-9661
Practice Address - Country:US
Practice Address - Phone:419-953-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401658920614374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide