MEDICARE: JENNIFER RENEE' PENN NURSING ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		OH
2	376K00000X	Nurse's Aide		OH

General Provider Information

NPI Number	:	1164761342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RENEE' PENN NURSING ASSISTANT

Provider Business Mailing Address
First Line	:	1726 BLUFF PL APT 3C
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-3173
Country	:	US
Telephone Number	:	937-838-6232
Fax Number	:

Provider Business Practice Location Address
First Line	:	1726 BLUFF PL APT 3C
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-3173
Country	:	US
Telephone Number	:	937-838-6232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	02/07/2013

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