Provider Demographics
NPI:1851336812
Name:CECCARDI, JENNIFER J (CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:CECCARDI
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 1:1622 E TURKEYFOOT LAKE RD
Mailing Address - Street 2:#301
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5277
Mailing Address - Country:US
Mailing Address - Phone:330-344-8565
Mailing Address - Fax:330-896-7085
Practice Address - Street 1:1622 E TURKEYFOOT LAKE RD
Practice Address - Street 2:#301
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5277
Practice Address - Country:US
Practice Address - Phone:330-344-8565
Practice Address - Fax:330-896-7085
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM-07497367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2567217Medicaid
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #