Provider Demographics
NPI:1700586575
Name:SUMMERALL, JENNETTE (HHA)
Entity Type:Individual
Prefix:MRS
First Name:JENNETTE
Middle Name:
Last Name:SUMMERALL
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 COURTRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3331
Mailing Address - Country:US
Mailing Address - Phone:614-373-7883
Mailing Address - Fax:
Practice Address - Street 1:1620 COURTRIGHT RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3331
Practice Address - Country:US
Practice Address - Phone:614-373-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide