Provider Demographics
NPI:1811650898
Name:HOSTETLER, JESSICA MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1552 N HONEYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9511
Mailing Address - Country:US
Mailing Address - Phone:330-264-0912
Mailing Address - Fax:330-263-4321
Practice Address - Street 1:1552 N HONEYTOWN RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-9511
Practice Address - Country:US
Practice Address - Phone:330-264-0912
Practice Address - Fax:330-263-4321
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.164074.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse