Provider Demographics
NPI:1699527689
Name:NORMAN, JENNIFER LYNETTE (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNETTE
Last Name:NORMAN
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 1:714 W BEECH ST
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3468
Mailing Address - Country:US
Mailing Address - Phone:423-912-3007
Mailing Address - Fax:
Practice Address - Street 1:714 W BEECH ST
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3468
Practice Address - Country:US
Practice Address - Phone:423-912-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN64202164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse