Healthcare Provider Details

I. General information

NPI: 1639266117
Provider Name (Legal Business Name): JENNIFER S. SHAMPTON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

1900 HAMLET DR
KETTERING OH
45440-1623
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-262-5998
Mailing address:
  • Phone: 937-298-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN 158985
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: