Provider Demographics
NPI:1558609891
Name:JANKOWSKI, NADINE (LMT, LPN)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:JANKOWSKI
Suffix:
Gender:F
Credentials:LMT, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5788 RIDGE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3162
Mailing Address - Country:US
Mailing Address - Phone:440-882-6985
Mailing Address - Fax:440-882-6702
Practice Address - Street 1:5788 RIDGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-3162
Practice Address - Country:US
Practice Address - Phone:440-882-6985
Practice Address - Fax:440-882-6702
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151251164W00000X
OH33-010596225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse