Provider Demographics
NPI:1649603523
Name:HATMAKER, JENNELL MARGARET (LPN)
Entity type:Individual
Prefix:
First Name:JENNELL
Middle Name:MARGARET
Last Name:HATMAKER
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 1:12917 BARRETTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-9474
Mailing Address - Country:US
Mailing Address - Phone:937-763-8272
Mailing Address - Fax:
Practice Address - Street 1:12917 BARRETTS MILL RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-9474
Practice Address - Country:US
Practice Address - Phone:937-763-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN130456IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse