Provider Demographics
NPI:1962074047
Name:THADEN, JENNIE MARIA
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:MARIA
Last Name:THADEN
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 1:5774 HENDRICKSON RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-9605
Mailing Address - Country:US
Mailing Address - Phone:513-520-7732
Mailing Address - Fax:
Practice Address - Street 1:5774 HENDRICKSON RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-9605
Practice Address - Country:US
Practice Address - Phone:513-520-7732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker