MEDICARE: JILLIAN JANE WHETSEL

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1609441484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN JANE WHETSEL

Provider Business Mailing Address
First Line	:	10008 CHARDON RD
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-8715
Country	:	US
Telephone Number	:	440-487-3872
Fax Number	:

Provider Business Practice Location Address
First Line	:	8903 JACKSON ST
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4321
Country	:	US
Telephone Number	:	440-487-3872
Fax Number	:

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

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	05/24/2021

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Directions to “ JILLIAN JANE WHETSEL ” Practice Location

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