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General NPI Number Information
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NPI Number | 1669652400
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Entity Type | Individual
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Provider Name | JESSICA A GUMUCIO NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-2811
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Country | US
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Telephone | 216-444-8078
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Fax | 216-636-2634
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Provider Business Mailing Address
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Address Line | 33355 HEALTH CAMPUS BLVD,
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City | AVON
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State | OH
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Zip | 44011-4404
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Country | US
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Telephone | 216-445-8442
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Fax | 216-636-2634
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP.8880
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN.CNP.021264
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License Number State | OH
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