Provider Demographics
NPI:1326227281
Name:MCDERMOTT, JENNIFER LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:601 S EDWIN C MOSES BLVD
Mailing Address - Street 2:SAMARITAN BEHAVIORAL HEALTH INC
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3424
Mailing Address - Country:US
Mailing Address - Phone:937-734-8333
Mailing Address - Fax:937-734-4343
Practice Address - Street 1:8320 KNISELEY RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-9422
Practice Address - Country:US
Practice Address - Phone:937-548-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN113503164W00000X
OHRN.410291163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse