Provider Demographics
NPI:1205324506
Name:KIRSCHENMAN, JENNIFER (CNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KIRSCHENMAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:SD
Mailing Address - Zip Code:57437-0185
Mailing Address - Country:US
Mailing Address - Phone:605-284-2503
Mailing Address - Fax:605-284-5307
Practice Address - Street 1:701 7TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:SD
Practice Address - Zip Code:57437-2175
Practice Address - Country:US
Practice Address - Phone:605-284-2503
Practice Address - Fax:605-284-5307
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 347C00000X, 376J00000X
SDA028863376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD20180507710214Medicaid