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General NPI Number Information
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NPI Number | 1730573965
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Entity Type | Individual
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Provider Name | JENNALEE CHAGIN NP
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Gender | Female
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 33 NORTH AVE
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City | TALLMADGE
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State | OH
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Zip | 44278-1925
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Country | US
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Telephone | 330-344-3990
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Fax | 330-634-9433
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Provider Business Mailing Address
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Address Line | 3420 WOOSTER RD 309
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City | ROCKY RIVER
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State | OH
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Zip | 44116-4174
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Country | US
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Telephone | 330-207-4121
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA.16982NP
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License Number State | OH
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