Provider Demographics
NPI:1235309717
Name:CROOM, JENNIFER JUANITA
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JUANITA
Last Name:CROOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JUANITA
Other - Last Name:MUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1724 TAYLOR RD
Mailing Address - Street 2:APT 1
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2888
Mailing Address - Country:US
Mailing Address - Phone:216-212-1015
Mailing Address - Fax:216-851-2781
Practice Address - Street 1:1724 TAYLOR RD
Practice Address - Street 2:APT 1
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2888
Practice Address - Country:US
Practice Address - Phone:216-212-1015
Practice Address - Fax:216-851-2781
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide