Provider Demographics
NPI:1588379705
Name:JENNINGS, ALYSSA LAJAE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LAJAE
Last Name:JENNINGS
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 1:905 N JAMESON AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2038
Mailing Address - Country:US
Mailing Address - Phone:937-877-7969
Mailing Address - Fax:
Practice Address - Street 1:905 N JAMESON AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2038
Practice Address - Country:US
Practice Address - Phone:937-877-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide