Healthcare Provider Details

I. General information

NPI: 1306348982
Provider Name (Legal Business Name): LAURA JANE JEROME FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVE
CLEVELAND OH
44111-5612
US

IV. Provider business mailing address

715 HAMMER CT
ELYRIA OH
44035-3030
US

V. Phone/Fax

Practice location:
  • Phone: 440-213-7217
  • Fax:
Mailing address:
  • Phone: 440-366-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.022353
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: