Provider Demographics
NPI:1639884000
Name:SHOWALTER, JACQUELYN RENEE (CNP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:RENEE
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 W MAIN RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2043
Mailing Address - Country:US
Mailing Address - Phone:440-599-2262
Mailing Address - Fax:
Practice Address - Street 1:354 W MAIN RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2043
Practice Address - Country:US
Practice Address - Phone:440-599-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.0031978207Q00000X
OHAPRN.CNP.0031978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine