Provider Demographics
NPI:1639475866
Name:WAITERS, JENNIFER ROSE (BC-ACPNP, BC-NNP)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ROSE
Last Name:WAITERS
Suffix:
Gender:F
Credentials:BC-ACPNP, BC-NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1572 LACLEDE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3012
Mailing Address - Country:US
Mailing Address - Phone:216-410-4398
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1716
Practice Address - Country:US
Practice Address - Phone:216-445-1580
Practice Address - Fax:216-445-3692
Is Sole Proprietor?:No
Enumeration Date:2011-02-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA12084-NP363LP0200X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal