Provider Demographics
NPI:1235974965
Name:WASHINGTON, JEANNINE S
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:S
Last Name:WASHINGTON
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 1:1720 APPLE ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-5741
Mailing Address - Country:US
Mailing Address - Phone:269-365-5242
Mailing Address - Fax:
Practice Address - Street 1:1377 BRIAR ROSE DR
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-2338
Practice Address - Country:US
Practice Address - Phone:810-484-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide