Provider Demographics
NPI:1477060440
Name:MERISE, JEAN FRITZNEL (MBA, CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:FRITZNEL
Last Name:MERISE
Suffix:
Gender:M
Credentials:MBA, CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1168
Mailing Address - Country:US
Mailing Address - Phone:347-982-1457
Mailing Address - Fax:
Practice Address - Street 1:2602 OAKSTONE DR STE 20
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-7613
Practice Address - Country:US
Practice Address - Phone:347-982-1457
Practice Address - Fax:347-982-1457
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910854Medicaid