Healthcare Provider Details

I. General information

NPI: 1033648290
Provider Name (Legal Business Name): JENNA ELIZABETH VALENCIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST
AKRON OH
44304-1619
US

IV. Provider business mailing address

8575 PARK RIDGE LN
MACEDONIA OH
44056-2055
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number372070
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number019565
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: