Provider Demographics
NPI:1992117519
Name:PIMENTEL, JELINDA VANLORA (LPN)
Entity type:Individual
Prefix:MISS
First Name:JELINDA
Middle Name:VANLORA
Last Name:PIMENTEL
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 1:7652 CTY RD B
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-9751
Mailing Address - Country:US
Mailing Address - Phone:920-373-5729
Mailing Address - Fax:
Practice Address - Street 1:7652 CTY RD B
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-9751
Practice Address - Country:US
Practice Address - Phone:920-373-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI318229-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse