Provider Demographics
NPI:1811134208
Name:CONVERSE, JENNIFER L (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CONVERSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:43107-1151
Mailing Address - Country:US
Mailing Address - Phone:740-569-5643
Mailing Address - Fax:
Practice Address - Street 1:225 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:OH
Practice Address - Zip Code:43107-1151
Practice Address - Country:US
Practice Address - Phone:740-654-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN328866163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse