1609016617 NPI number — JENNIFER G HELLER CRNP

Table of content: JENNIFER G HELLER CRNP (NPI 1609016617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609016617 NPI number — JENNIFER G HELLER CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HELLER
Provider First Name:
JENNIFER
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUCKER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609016617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 CARROLL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44304-1934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-361-1223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
468 E MARKET ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44304-1594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
234-312-3607
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  COA 10616-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2933099 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".