Provider Demographics
NPI:1295857522
Name:DORSEY, JERI AQUANETTA
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:AQUANETTA
Last Name:DORSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 N JENKINS BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3712
Mailing Address - Country:US
Mailing Address - Phone:330-622-9839
Mailing Address - Fax:
Practice Address - Street 1:983 N JENKINS BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3712
Practice Address - Country:US
Practice Address - Phone:330-622-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2586134Medicaid