Provider Demographics
NPI:1467661058
Name:MAXWELL, JENNY SUE (LPN)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:SUE
Last Name:MAXWELL
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 1:470 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5839
Mailing Address - Country:US
Mailing Address - Phone:440-310-1819
Mailing Address - Fax:
Practice Address - Street 1:5320 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-1820
Practice Address - Country:US
Practice Address - Phone:440-327-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 111411164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse