Healthcare Provider Details

I. General information

NPI: 1215850094
Provider Name (Legal Business Name): JASON ANDREW FAWLEY APRN.CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 S BROADWAY
LORAIN OH
44053-3821
US

IV. Provider business mailing address

6140 S BROADWAY
LORAIN OH
44053-3821
US

V. Phone/Fax

Practice location:
  • Phone: 440-233-7232
  • Fax: 440-233-9070
Mailing address:
  • Phone: 440-233-7232
  • Fax: 440-233-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042701
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: