MEDICARE: JENNIFER LYNN HANSHAW LPN

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
1	164W00000X	Licensed Practical Nurse	PN 123486	OH

General Provider Information

NPI Number	:	1598916108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN HANSHAW LPN

Provider Business Mailing Address
First Line	:	200 WILLIS DR LOT 128
Second Line	:
City	:	SOUTH ZANESVILLE
State	:	OH
Zip	:	43701-7419
Country	:	US
Telephone Number	:	740-452-2329
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 N PEMBROKE AVE
Second Line	:
City	:	SOUTH ZANESVILLE
State	:	OH
Zip	:	43701-6261
Country	:	US
Telephone Number	:	740-624-5874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	01/28/2020

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