Provider Demographics
NPI:1609441484
Name:WHETSEL, JILLIAN JANE
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:JANE
Last Name:WHETSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10008 CHARDON RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-8715
Mailing Address - Country:US
Mailing Address - Phone:440-487-3872
Mailing Address - Fax:
Practice Address - Street 1:8903 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4321
Practice Address - Country:US
Practice Address - Phone:440-487-3872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty