Healthcare Provider Details

I. General information

NPI: 1063784080
Provider Name (Legal Business Name): JEANNE HALL QBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30432 EUCLID AVE SUITE #224
WICKLIFFE OH
44092-1578
US

IV. Provider business mailing address

14 LOIS LN
CHARDON OH
44024-9203
US

V. Phone/Fax

Practice location:
  • Phone: 440-228-0464
  • Fax:
Mailing address:
  • Phone: 440-228-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: