=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982039186
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNA M SEAVEY CNS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2013
-----------------------------------------------------
Last Update Date | 12/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6847 N. CHESTNUT STREET SUITE 200
-----------------------------------------------------
City | RAVENNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-296-9606
-----------------------------------------------------
Fax | 330-297-9835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6847 N CHESTNUT ST STE 200
-----------------------------------------------------
City | RAVENNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44266-3929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-618-2732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN 350791
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364SA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | COA-15137-NS
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------