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General NPI Number Information
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NPI Number | 1003218157
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Entity Type | Individual
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Provider Name | KRISTINE JENNE LPN
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Gender | Female
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 164 HANNUM AVE
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City | ROSSFORD
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State | OH
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Zip | 43460-1110
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Country | US
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Telephone | 419-377-0045
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Fax |
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Provider Business Mailing Address
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Address Line | 164 HANNUM AVE
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City | ROSSFORD
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State | OH
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Zip | 43460-1110
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Country | US
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Telephone | 419-377-0045
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN-062301
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703088946
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License Number State | MI
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