Provider Demographics
NPI:1699380261
Name:WHITE, JEAN NICOLE
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:NICOLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:NICOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 GREENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-9185
Mailing Address - Country:US
Mailing Address - Phone:440-361-4493
Mailing Address - Fax:440-361-4493
Practice Address - Street 1:250 GREENRIDGE DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-9185
Practice Address - Country:US
Practice Address - Phone:440-361-4493
Practice Address - Fax:440-361-4493
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0402040253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care