Provider Demographics
NPI:1083737373
Name:JARRETT, VANESSA M (LPN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:JARRETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 W GOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1633
Mailing Address - Country:US
Mailing Address - Phone:330-209-4350
Mailing Address - Fax:330-209-4350
Practice Address - Street 1:159 W GOOD AVE
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1633
Practice Address - Country:US
Practice Address - Phone:330-209-4350
Practice Address - Fax:330-209-4350
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 115822164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2700894Medicaid