Healthcare Provider Details

I. General information

NPI: 1568961886
Provider Name (Legal Business Name): JENNIFER MARIE TRUBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 LEICESTER PL
COLUMBUS OH
43235-2181
US

IV. Provider business mailing address

1207 LEICESTER PL
COLUMBUS OH
43235-2181
US

V. Phone/Fax

Practice location:
  • Phone: 614-537-5371
  • Fax:
Mailing address:
  • Phone: 614-537-5371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: