MEDICARE: JACQUELYN ANNE EUREKA RN, BSN

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	386857	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0026802	OH

General Provider Information

NPI Number	:	1639703200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN ANNE EUREKA RN, BSN

Provider Business Mailing Address
First Line	:	17045 GREENWOOD DR
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44149-5822
Country	:	US
Telephone Number	:	330-636-1908
Fax Number	:

Provider Business Practice Location Address
First Line	:	6605 CENTER RD
Second Line	:
City	:	VALLEY CITY
State	:	OH
Zip	:	44280-9748
Country	:	US
Telephone Number	:	330-483-3135
Fax Number	:

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

Provider Enumeration Date	:	02/23/2020
Last Update Date	:	05/13/2022

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