Healthcare Provider Details

I. General information

NPI: 1609705334
Provider Name (Legal Business Name): JENNA PAULUS RN, LSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 ENON XENIA PIKE
ENON OH
45323-1759
US

IV. Provider business mailing address

510 ENON XENIA PIKE
ENON OH
45323-1759
US

V. Phone/Fax

Practice location:
  • Phone: 937-864-7348
  • Fax: 937-864-6009
Mailing address:
  • Phone: 937-864-7348
  • Fax: 937-864-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.335344
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: