Provider Demographics
NPI:1245643725
Name:JENNINE
Entity type:Organization
Organization Name:JENNINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT CARE GIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNINE
Authorized Official - Middle Name:ANTIONETTE
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:414-795-5753
Mailing Address - Street 1:717 LAND PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-2358
Mailing Address - Country:US
Mailing Address - Phone:414-795-5753
Mailing Address - Fax:
Practice Address - Street 1:717 LAND PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2358
Practice Address - Country:US
Practice Address - Phone:414-795-5753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI200568-30251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health