Provider Demographics
NPI:1851569032
Name:BELASCO, JEAN LYNN (LPN)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:LYNN
Last Name:BELASCO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4908 W SPRAGUE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6393
Mailing Address - Country:US
Mailing Address - Phone:440-886-2676
Mailing Address - Fax:
Practice Address - Street 1:4908 W SPRAGUE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-6393
Practice Address - Country:US
Practice Address - Phone:440-886-2676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.074057 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2631629Medicaid