Provider Demographics
NPI:1194096024
Name:THURMOND, JENNIFER LORENE (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LORENE
Last Name:THURMOND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 YOUNG RD
Mailing Address - Street 2:
Mailing Address - City:MEDON
Mailing Address - State:TN
Mailing Address - Zip Code:38356-6834
Mailing Address - Country:US
Mailing Address - Phone:731-609-3450
Mailing Address - Fax:
Practice Address - Street 1:190 YOUNG RD
Practice Address - Street 2:
Practice Address - City:MEDON
Practice Address - State:TN
Practice Address - Zip Code:38356-6834
Practice Address - Country:US
Practice Address - Phone:731-609-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN139677163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy