Provider Demographics
NPI:1740623594
Name:KANAPECKAS, JILL LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LYNN
Last Name:KANAPECKAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6219 HWY 184 E
Mailing Address - Street 2:CHEROKEE TRAIL ELEMENTARY SCHOOL
Mailing Address - City:DONALDS
Mailing Address - State:SC
Mailing Address - Zip Code:29638-8877
Mailing Address - Country:US
Mailing Address - Phone:864-379-8500
Mailing Address - Fax:864-379-8509
Practice Address - Street 1:6219 HWY 184 E
Practice Address - Street 2:CHEROKEE TRAIL ELEMENTARY SCHOOL
Practice Address - City:DONALDS
Practice Address - State:SC
Practice Address - Zip Code:29638-8877
Practice Address - Country:US
Practice Address - Phone:864-379-8500
Practice Address - Fax:864-379-8509
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPR27369164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse