Individual
JACK O'NEILL HAGGERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
304 N MAIN ST APT B, MOUNT VERNON, OH 43050-2099
(740) 358-3950
Mailing address
304 N MAIN ST APT B, MOUNT VERNON, OH 43050-2099
(740) 358-3950
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN154443
OH
Other
Enumeration date
05/04/2018
Last updated
05/04/2018
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