Provider Demographics
NPI:1962052902
Name:HALL, JENNIFER A (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:ADRIENNE
Other - Middle Name:A
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:4480 STATE ROUTE 43 APT 8
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6971
Mailing Address - Country:US
Mailing Address - Phone:216-799-4571
Mailing Address - Fax:
Practice Address - Street 1:4480 STATE ROUTE 43 APT 8
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6971
Practice Address - Country:US
Practice Address - Phone:216-799-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH99999999999999999999Medicaid