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General NPI Number Information
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NPI Number | 1336004530
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Entity Type | Organization
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Legal Business Name | JEREMIAH 33:6 VIRTUAL HEALTH CLINIC LLC
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Dates
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Enumeration Date | 12/19/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 1065 ROSEALEE AVE
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City | ELYRIA
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State | OH
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Zip | 44035-2945
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Country | US
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Telephone | 440-309-3823
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Fax |
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Provider Business Mailing Address
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Address Line | 1065 ROSEALEE AVE
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City | ELYRIA
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State | OH
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Zip | 44035-2945
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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 | OWNER
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Name | MRS. CANDACE LEE BOLARINWA
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Credential | APRN-CNP
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Telephone | 440-309-3823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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