Healthcare Provider Details

I. General information

NPI: 1316366099
Provider Name (Legal Business Name): JENNIFER LYNNE WHITEHEAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNNE HARRIS

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W HIGH ST STE 102
LIMA OH
45801-3972
US

IV. Provider business mailing address

830 W HIGH ST ST 102
LIMA OH
45801-3971
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-4045
  • Fax: 419-228-5665
Mailing address:
  • Phone: 419-222-4045
  • Fax: 419-228-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number131285
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number131285
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: