Healthcare Provider Details

I. General information

NPI: 1508092941
Provider Name (Legal Business Name): JENNIFER LEABELL ERNSBERGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6569 STATE ROUTE 4
BLOOMVILLE OH
44818-9347
US

IV. Provider business mailing address

6569 STATE ROUTE 4
BLOOMVILLE OH
44818-9347
US

V. Phone/Fax

Practice location:
  • Phone: 419-988-0205
  • Fax: 419-988-0259
Mailing address:
  • Phone: 419-988-0205
  • Fax: 419-988-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.317576
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: