Individual
JACLYN LENAI MALLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
750 CHEYENNE PL, TIPP CITY, OH 45371-1507
(757) 770-7860
Mailing address
750 CHEYENNE PL, TIPP CITY, OH 45371-1507
(757) 770-7860
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.144901-M-IV
OH
Other
Enumeration date
08/13/2012
Last updated
08/13/2012
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