Provider Demographics
NPI:1649578261
Name:NORMAN, JENNIFER (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 ABERDEEN AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-5135
Mailing Address - Country:US
Mailing Address - Phone:440-645-2040
Mailing Address - Fax:
Practice Address - Street 1:2920 ABERDEEN AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5135
Practice Address - Country:US
Practice Address - Phone:440-645-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH500838163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068830Medicaid