Provider Demographics
NPI:1528318219
Name:WADE, JENNIFER M (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WADE
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 1:165 E OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:OH
Mailing Address - Zip Code:44672-1410
Mailing Address - Country:US
Mailing Address - Phone:330-257-1780
Mailing Address - Fax:
Practice Address - Street 1:165 E OHIO AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:OH
Practice Address - Zip Code:44672-1410
Practice Address - Country:US
Practice Address - Phone:330-257-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147731164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse