Provider Demographics
NPI:1881005122
Name:GAZSO, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:GAZSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1120
Mailing Address - Country:US
Mailing Address - Phone:440-867-0030
Mailing Address - Fax:
Practice Address - Street 1:7757 AUBURN RD STE 6
Practice Address - Street 2:
Practice Address - City:CONCORD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44077-9604
Practice Address - Country:US
Practice Address - Phone:440-350-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-267371163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse