Provider Demographics
NPI:1689191082
Name:NAELITZ, JAMES MARK
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARK
Last Name:NAELITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-2031
Mailing Address - Country:US
Mailing Address - Phone:440-204-5772
Mailing Address - Fax:
Practice Address - Street 1:2333 E 35TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2031
Practice Address - Country:US
Practice Address - Phone:440-204-5772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165298Medicaid