Healthcare Provider Details

I. General information

NPI: 1316034077
Provider Name (Legal Business Name): JEANNE OLGA PEARL REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 MARIAN DR
LYNDHURST OH
44124-1228
US

IV. Provider business mailing address

5265 MARIAN DR
LYNDHURST OH
44124-1228
US

V. Phone/Fax

Practice location:
  • Phone: 440-449-2782
  • Fax:
Mailing address:
  • Phone: 440-449-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number102215
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: