Provider Demographics
NPI:1356015135
Name:CRENSHAW, JAYLAN WEBBER
Entity Type:Individual
Prefix:
First Name:JAYLAN
Middle Name:WEBBER
Last Name:CRENSHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 MOELLER AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1762
Mailing Address - Country:US
Mailing Address - Phone:234-200-9418
Mailing Address - Fax:
Practice Address - Street 1:990 MOELLER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1762
Practice Address - Country:US
Practice Address - Phone:234-200-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTY003657374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide