Healthcare Provider Details

I. General information

NPI: 1992266415
Provider Name (Legal Business Name): JENNIFER JAMERINO-THRUSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W BOWERY ST
AKRON OH
44308-1046
US

IV. Provider business mailing address

7484 STONEVALLEY BLF
CLARKSTON MI
48348-4376
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-1000
  • Fax:
Mailing address:
  • Phone: 586-913-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301510281
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: