Provider Demographics
NPI:1265169924
Name:JEAN, SARA ASHLEY (LPN)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ASHLEY
Last Name:JEAN
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 1:338A PLEASANT HILL COOPER RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8982
Mailing Address - Country:US
Mailing Address - Phone:740-464-3744
Mailing Address - Fax:
Practice Address - Street 1:338A PLEASANT HILL COOPER RD
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8982
Practice Address - Country:US
Practice Address - Phone:740-464-3744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148879164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse