1083959985 NPI number — MRS. JENNIFER A BEALE BSN, CRRN, CCM

Table of content: (NPI 1790437929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083959985 NPI number — MRS. JENNIFER A BEALE BSN, CRRN, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEALE
Provider First Name:
JENNIFER
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BSN, CRRN, CCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROSS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083959985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 LILLIAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOW
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44224-2535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-256-0567
Provider Business Mailing Address Fax Number:
330-688-4024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 LILLIAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOW
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44224-2535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-256-0567
Provider Business Practice Location Address Fax Number:
330-688-4024
Provider Enumeration Date:
12/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  170457 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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