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General NPI Number Information
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NPI Number | 1740115310
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Entity Type | Individual
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Provider Name | JENNIFER CLYDESDALE
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Gender | Female
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Dates
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Enumeration Date | 06/16/2026
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Last Update Date | 06/16/2026
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Provider Practice Location Address
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Address Line | 1949 E 300TH ST
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City | WICKLIFFE
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State | OH
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Zip | 44092-1646
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Country | US
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Telephone | 440-487-2035
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Fax |
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Provider Business Mailing Address
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Address Line | 1949 E 300TH ST
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City | WICKLIFFE
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State | OH
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Zip | 44092-1646
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Country | US
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Telephone | 440-487-2035
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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 | 163WC1600X
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Taxonomy Name | Continuing Education/Staff Development Registered Nurse
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License Number | RN.371652
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License Number State | OH
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