Provider Demographics
NPI:1023314622
Name:MOWRY, JENNIFER MELYNN (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MELYNN
Last Name:MOWRY
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 1:2714 CABANAYAN ST APT D
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5031
Mailing Address - Country:US
Mailing Address - Phone:870-917-4231
Mailing Address - Fax:
Practice Address - Street 1:2714 CABANAYAN ST APT D
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-5031
Practice Address - Country:US
Practice Address - Phone:870-917-4231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70160164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse