Individual
MRS. JACKLYN ELAINE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1905 PERRYSBURG HOLLAND RD, HOLLAND, OH 43528-9582
(419) 324-0949
Mailing address
1905 PERRYSBURG HOLLAND RD, HOLLAND, OH 43528-9582
(419) 324-0949
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN.110467.MEDS
OH
164W00000X
Licensed Practical Nurse
PN-110467
OH
Other
Enumeration date
05/25/2007
Last updated
06/09/2025
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