Provider Demographics
NPI:1619311107
Name:ELDER, JENE RAENEL (LPN)
Entity type:Individual
Prefix:MRS
First Name:JENE
Middle Name:RAENEL
Last Name:ELDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4185 OLD RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1457
Mailing Address - Country:US
Mailing Address - Phone:937-829-3434
Mailing Address - Fax:
Practice Address - Street 1:4185 OLD RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1457
Practice Address - Country:US
Practice Address - Phone:937-829-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN114520164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse