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General NPI Number Information
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NPI Number | 1841407293
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Entity Type | Individual
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Provider Name | JESSICA LYNN DERWENT STNA
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 109 MUIRWOOD VILLAGE DR
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City | DELAWARE
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State | OH
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Zip | 43015-1082
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Country | US
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Telephone | 740-369-2213
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Fax |
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Provider Business Mailing Address
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Address Line | 1909 ST. RT. 257 N
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City | OSTRANDER
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State | OH
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Zip | 43061-9721
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Country | US
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Telephone | 740-272-8099
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 2663550
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License Number State | OH
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