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General NPI Number Information
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NPI Number | 1043557390
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Entity Type | Organization
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Legal Business Name | SHRIVER FAMILY PRACTICE LTD.
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 294 E MAIN ST
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City | JACKSON
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State | OH
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Zip | 45640-1745
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Country | US
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Telephone | 740-577-3132
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Fax | 740-577-3156
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Provider Business Mailing Address
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Address Line | 294 E MAIN ST
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City | JACKSON
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State | OH
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Zip | 45640-1745
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Country | US
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Telephone | 740-577-3132
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Fax | 740-577-3156
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JEANETTA J SHRIVER
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Credential | FNP-BC
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Telephone | 740-577-3132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA12752
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License Number State | OH
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