Provider Demographics
NPI:1356988968
Name:BLACKBURN, JENIFER
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:BLACKBURN
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:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:44251-0160
Mailing Address - Country:US
Mailing Address - Phone:330-204-6544
Mailing Address - Fax:
Practice Address - Street 1:8993 POMANDER WALK
Practice Address - Street 2:
Practice Address - City:WESTFIELD CENTER
Practice Address - State:OH
Practice Address - Zip Code:44251-9738
Practice Address - Country:US
Practice Address - Phone:330-204-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide