Provider Demographics
NPI:1285330498
Name:RAFFLE, JADE NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:NICOLE
Last Name:RAFFLE
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 1:15655 STATE ROUTE 170
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9069
Mailing Address - Country:US
Mailing Address - Phone:330-386-4303
Mailing Address - Fax:
Practice Address - Street 1:15655 STATE ROUTE 170
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9069
Practice Address - Country:US
Practice Address - Phone:330-386-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.165995164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse