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General NPI Number Information
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NPI Number | 1275370959
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Entity Type | Individual
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Provider Name | JENNIFER LYNN WYROCK AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/10/2024
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE # A30
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-445-3295
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Fax | 216-445-8627
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Provider Business Mailing Address
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Address Line | 754 S CLEVELAND AVE STE 300
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City | MOGADORE
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State | OH
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Zip | 44260-2210
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Country | US
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Telephone | 330-877-3008
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Fax | 330-877-2967
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.0036967
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License Number State | OH
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