Provider Demographics
NPI:1154606135
Name:JENNINGS, RACHELLE CHERIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:CHERIE
Last Name:JENNINGS
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 1:220 WEST RD
Mailing Address - Street 2:APT 15
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-5718
Mailing Address - Country:US
Mailing Address - Phone:910-263-9571
Mailing Address - Fax:
Practice Address - Street 1:220 WEST RD
Practice Address - Street 2:APT 15
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-5718
Practice Address - Country:US
Practice Address - Phone:910-263-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283474-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse