Healthcare Provider Details

I. General information

NPI: 1710790712
Provider Name (Legal Business Name): JANET MICKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 RIDGEWOOD RD
MEDINA OH
44256-8755
US

IV. Provider business mailing address

2935 RIDGEWOOD RD
MEDINA OH
44256-8755
US

V. Phone/Fax

Practice location:
  • Phone: 440-773-5457
  • Fax:
Mailing address:
  • Phone: 216-513-7085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: