Provider Demographics
NPI:1427647171
Name:CALHOUN, JEANINE M
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:M
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1258
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1008
Mailing Address - Country:US
Mailing Address - Phone:732-806-5799
Mailing Address - Fax:732-487-3670
Practice Address - Street 1:186 WILLIAMSBURG LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1475
Practice Address - Country:US
Practice Address - Phone:732-806-5799
Practice Address - Fax:732-487-3670
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNA107355376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNA107355OtherNH DOH