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NPI Code Detail

MEDICARE: JENNIFER J SHOCKLEY RN

MEDICARE: JENNIFER J SHOCKLEY RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN.511219OH

General Provider Information

NPI Number : 1205191723
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER J SHOCKLEY RN
Provider Business Mailing Address
First Line : 615 ELSINORE PL STE 200
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-1457
Country : US
Telephone Number : 513-834-7063
Fax Number :
Provider Business Practice Location Address
First Line : 485 W MAIN ST
Second Line :
City : WILMINGTON
State : OH
Zip : 45177-2174
Country : US
Telephone Number : 513-834-7063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2012
Last Update Date : 09/07/2022

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