Healthcare Provider Details

I. General information

NPI: 1467757500
Provider Name (Legal Business Name): JENNA RANAE LINTON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 TAYLOR AVE
NEWARK OH
43055-6032
US

IV. Provider business mailing address

1140 TAYLOR AVE NEWARK
NEWARK OH
43055-6032
US

V. Phone/Fax

Practice location:
  • Phone: 740-258-3766
  • Fax:
Mailing address:
  • Phone: 740-258-3766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.346106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: