Healthcare Provider Details

I. General information

NPI: 1588901870
Provider Name (Legal Business Name): JENNIFER ELIESA HOCKENBERRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 WESTBROOK RD
DAYTON OH
45415-2437
US

IV. Provider business mailing address

145 WESTBROOK RD
DAYTON OH
45415-2437
US

V. Phone/Fax

Practice location:
  • Phone: 937-308-7202
  • Fax:
Mailing address:
  • Phone: 937-308-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN365187
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: