Provider Demographics
NPI:1427323807
Name:WARE, JAQUITA J (LPN)
Entity type:Individual
Prefix:
First Name:JAQUITA
Middle Name:J
Last Name:WARE
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 1:711 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45203-3102
Mailing Address - Country:US
Mailing Address - Phone:513-462-6656
Mailing Address - Fax:
Practice Address - Street 1:711 CLARK ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45203-3102
Practice Address - Country:US
Practice Address - Phone:513-462-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144439164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse