Healthcare Provider Details

I. General information

NPI: 1639769011
Provider Name (Legal Business Name): JENNIFER MESSER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 09/21/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 E MCPHERSON HWY
CLYDE OH
43410
US

IV. Provider business mailing address

435 RAWSON AVE
FREMONT OH
43420-2126
US

V. Phone/Fax

Practice location:
  • Phone: 419-626-6161
  • Fax:
Mailing address:
  • Phone: 419-307-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0032297
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.348787
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: