MEDICARE: STEFFANIE ROSE JEWELL-GENS

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	:	1770075095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFFANIE ROSE JEWELL-GENS

Provider Business Mailing Address
First Line	:	2042 HIGH ST
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-4146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2042 HIGH STREET
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221
Country	:	US
Telephone Number	:	330-289-5877
Fax Number	:

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

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	06/01/2018

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