Provider Demographics
NPI:1285659359
Name:SWEENEY, JEAN E (CNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 BROOKPARK RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1009
Mailing Address - Country:US
Mailing Address - Phone:216-398-0349
Mailing Address - Fax:216-398-0529
Practice Address - Street 1:4503 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1009
Practice Address - Country:US
Practice Address - Phone:216-398-0349
Practice Address - Fax:216-398-0529
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP5094363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2172812Medicaid
OHP07532Medicare UPIN