Provider Demographics
NPI:1184071581
Name:STILLWELL, JESSIE (LPN)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:STILLWELL
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 1:1208 DESERT ST NE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8568
Mailing Address - Country:US
Mailing Address - Phone:330-618-1866
Mailing Address - Fax:
Practice Address - Street 1:1208 DESERT ST NE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8568
Practice Address - Country:US
Practice Address - Phone:330-618-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15904163W00000X
OHPN121401164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse