Provider Demographics
NPI:1497030811
Name:SHRIVER, JEANETTA JEAN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTA
Middle Name:JEAN
Last Name:SHRIVER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:JEANETTA
Other - Middle Name:JEAN
Other - Last Name:SHRIVER FNP-BC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN FNP-BC
Mailing Address - Street 1:294 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1745
Mailing Address - Country:US
Mailing Address - Phone:740-577-3132
Mailing Address - Fax:740-577-3156
Practice Address - Street 1:294 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1745
Practice Address - Country:US
Practice Address - Phone:740-577-3132
Practice Address - Fax:740-577-3156
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA12752-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily