Provider Demographics
NPI:1700829942
Name:CARR, JEANETTE MARIA (CNM)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIA
Last Name:CARR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 NOBLESHIRE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1326
Mailing Address - Country:US
Mailing Address - Phone:216-382-1650
Mailing Address - Fax:
Practice Address - Street 1:2026 LEE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2536
Practice Address - Country:US
Practice Address - Phone:216-371-4848
Practice Address - Fax:216-371-3364
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155092163WM0102X
OHNM03435367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0859674Medicaid
OH0859674Medicaid