Provider Demographics
NPI:1558018986
Name:CRUMEDY, JENNIFER L (STNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CRUMEDY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 E 127TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4738
Mailing Address - Country:US
Mailing Address - Phone:216-254-0242
Mailing Address - Fax:
Practice Address - Street 1:4060 E 127TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4738
Practice Address - Country:US
Practice Address - Phone:216-254-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
402094680718376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty