Healthcare Provider Details

I. General information

NPI: 1831619303
Provider Name (Legal Business Name): JEAN BJORN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 SMITH RD
BROOKPARK OH
44142-2028
US

IV. Provider business mailing address

1084 LAKE POINT DR
LAKEWOOD OH
44107
US

V. Phone/Fax

Practice location:
  • Phone: 216-453-1111
  • Fax: 216-362-6855
Mailing address:
  • Phone: 216-362-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.217467
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: