Provider Demographics
NPI:1396029658
Name:BORYS, JENNELL LEE (NP-C)
Entity Type:Individual
Prefix:
First Name:JENNELL
Middle Name:LEE
Last Name:BORYS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AKRON GENERAL AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2432
Mailing Address - Country:US
Mailing Address - Phone:330-344-6015
Mailing Address - Fax:330-344-6820
Practice Address - Street 1:1 AKRON GENERAL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2432
Practice Address - Country:US
Practice Address - Phone:330-344-6015
Practice Address - Fax:330-344-6820
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-325899-COA1163W00000X
OHCOA-12650-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1821035940OtherAKRON GENERAL INTERNAL MEDICINE CENTER OF AKRON TYPE 2 NPI #
OH0454744OtherAKRON GENERAL INTERNAL MEDICINE CENTER OF AKRON MEDICAID #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH3600271OtherAKRON GENERAL INTERNAL MEDICINE CENTER OF AKRON MEDICARE GROUP #
OH0073446Medicaid
OH0073446Medicaid