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General NPI Number Information
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NPI Number | 1285915702
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Entity Type | Individual
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Provider Name | JACQUELYN M GILL CNP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE # E1-001
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City | CLEVELAND
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State | OH
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Zip | 44195-2433
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Country | US
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Telephone | 216-444-8486
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Fax |
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Provider Business Mailing Address
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Address Line | 190 CHESTER AVE
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City | WADSWORTH
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State | OH
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Zip | 44281-8363
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Country | US
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Telephone |
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | COA.12510-NP
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License Number State | OH
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