MEDICARE: JADESOLA SOREMEKUN 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	164W00000X	Licensed Practical Nurse	128591-IV	OH
2	163W00000X	Registered Nurse	RN388229	OH

General Provider Information

NPI Number	:	1548549843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADESOLA SOREMEKUN RN

Provider Business Mailing Address
First Line	:	24113 E SILSBY RD
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-1277
Country	:	US
Telephone Number	:	216-622-5322
Fax Number	:

Provider Business Practice Location Address
First Line	:	893 BEVERLY RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-2003
Country	:	US
Telephone Number	:	216-262-2246
Fax Number	:

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

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	01/28/2019

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