Healthcare Provider Details

I. General information

NPI: 1083357990
Provider Name (Legal Business Name): JENNIFER MARY HUGHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MESSIMER DR
NEWARK OH
43055-1841
US

IV. Provider business mailing address

15 MESSIMER DR
NEWARK OH
43055-1841
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4677
  • Fax:
Mailing address:
  • Phone: 220-564-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNM.0019498
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: