Provider Demographics
NPI:1295891901
Name:QUINLAN, JENNIFER L (LPN)
Entity type:Individual
Prefix:MR
First Name:JENNIFER
Middle Name:L
Last Name:QUINLAN
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 1:2607 KAROK DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9021
Mailing Address - Country:US
Mailing Address - Phone:740-852-4195
Mailing Address - Fax:740-852-4195
Practice Address - Street 1:2607 KAROK DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9021
Practice Address - Country:US
Practice Address - Phone:740-852-4195
Practice Address - Fax:740-852-4195
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN092940164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2082562Medicaid