MEDICARE: JAZMINE NICOLE VANCE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	437007	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	437007	OTHER	OH	RN LICENSURE

General Provider Information

NPI Number	:	1366100315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMINE NICOLE VANCE RN

Provider Business Mailing Address
First Line	:	4519 W 154TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-2709
Country	:	US
Telephone Number	:	216-355-4016
Fax Number	:

Provider Business Practice Location Address
First Line	:	4519 W 154TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-2709
Country	:	US
Telephone Number	:	216-355-4016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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