Provider Demographics
NPI:1609407881
Name:MCCLAIN, JENNIFER JONELL (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JONELL
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 STEPHENS CIR NW STE 202
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3645
Mailing Address - Country:US
Mailing Address - Phone:330-754-4431
Mailing Address - Fax:330-244-8839
Practice Address - Street 1:4580 STEPHENS CIR NW STE 202
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3645
Practice Address - Country:US
Practice Address - Phone:330-754-4431
Practice Address - Fax:330-244-8839
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026236363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology