Provider Demographics
NPI:1619405230
Name:FUSCO, JENNIFER LORRAINE (RN, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:FUSCO
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LORRAINE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4047 CASCADE DRIVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511
Mailing Address - Country:US
Mailing Address - Phone:330-303-8234
Mailing Address - Fax:
Practice Address - Street 1:15303 STATE ROUTE 170
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9585
Practice Address - Country:US
Practice Address - Phone:330-385-1000
Practice Address - Fax:330-385-3588
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.397483163WP0808X
OHAPRN.CNP.021505363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty