Provider Demographics
NPI:1114653441
Name:SIGGERS, JAEDA DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:JAEDA
Middle Name:DENISE
Last Name:SIGGERS
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 1:1631 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5071
Mailing Address - Country:US
Mailing Address - Phone:216-609-2266
Mailing Address - Fax:
Practice Address - Street 1:1631 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5071
Practice Address - Country:US
Practice Address - Phone:216-609-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.181336.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse