Physician Compare National (NPI:1497030811)

HEALTHCARE PROVIDER: JEANETTA JEAN SHRIVER FNP-BC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1497030811
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7517127715
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120326000712
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHRIVER
	Individual professional last name
Provider First Name	JEANETTA
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	294 E MAIN ST
	Group Practice or individual's line 1 address
City	JACKSON
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	456401745
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7405773132
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360159
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ADENA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y