Provider Demographics
NPI:1669791380
Name:WADLINGTON, JANNALLA (LPN)
Entity type:Individual
Prefix:MRS
First Name:JANNALLA
Middle Name:
Last Name:WADLINGTON
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 1:3323 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1819
Mailing Address - Country:US
Mailing Address - Phone:614-378-4936
Mailing Address - Fax:614-308-0981
Practice Address - Street 1:3323 OAKDALE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1819
Practice Address - Country:US
Practice Address - Phone:614-378-4936
Practice Address - Fax:614-308-0981
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104878164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse