Healthcare Provider Details

I. General information

NPI: 1649578261
Provider Name (Legal Business Name): JENNIFER NORMAN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2011
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 ABERDEEN AVE
ASHTABULA OH
44004-5135
US

IV. Provider business mailing address

2920 ABERDEEN AVE
ASHTABULA OH
44004-5135
US

V. Phone/Fax

Practice location:
  • Phone: 440-645-2040
  • Fax:
Mailing address:
  • Phone: 440-645-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number500838
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: