Provider Demographics
NPI:1396348389
Name:ALBERTS, JENNIFER LEE (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:ALBERTS
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 1:202 N IRVINE ST
Mailing Address - Street 2:
Mailing Address - City:AROMA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60910-1062
Mailing Address - Country:US
Mailing Address - Phone:815-592-3625
Mailing Address - Fax:
Practice Address - Street 1:157 BROZZINI CT STE A-D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5340
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPN.52393.PR164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse