Provider Demographics
NPI:1104646371
Name:KELLNER, THOMASINA JEAN (LPN)
Entity type:Individual
Prefix:
First Name:THOMASINA
Middle Name:JEAN
Last Name:KELLNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3364 GUN BARREL RD NE
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43150-9727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6150 THORNVILLE RD NE
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43150-9740
Practice Address - Country:US
Practice Address - Phone:614-530-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122939164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse