Provider Demographics
NPI:1629670641
Name:FIELDS, JEANNIE H
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:H
Last Name:FIELDS
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 1:7207 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-4819
Mailing Address - Country:US
Mailing Address - Phone:440-444-8837
Mailing Address - Fax:
Practice Address - Street 1:7207 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-4819
Practice Address - Country:US
Practice Address - Phone:440-444-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1818877Medicaid
OHODJFS-0075791Medicaid