Provider Demographics
NPI:1821248501
Name:MADDOX, JENNIFER DENICE (CNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENICE
Last Name:MADDOX
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 E 131ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2041
Mailing Address - Country:US
Mailing Address - Phone:216-702-5964
Mailing Address - Fax:
Practice Address - Street 1:990 EAST 131 ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2041
Practice Address - Country:US
Practice Address - Phone:216-702-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker