Provider Demographics
NPI:1376291047
Name:MYERS, JADA DAWN
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:DAWN
Last Name:MYERS
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 1:749 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-2206
Mailing Address - Country:US
Mailing Address - Phone:419-610-6717
Mailing Address - Fax:
Practice Address - Street 1:749 CHARLES ST
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-2206
Practice Address - Country:US
Practice Address - Phone:419-610-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1701269376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker