Provider Demographics
NPI:1891289674
Name:VADNAIS, JESSIE MARIE (CPNP- PC)
Entity Type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:MARIE
Last Name:VADNAIS
Suffix:
Gender:F
Credentials:CPNP- PC
Other - Prefix:MISS
Other - First Name:JESSIE
Other - Middle Name:MARIE
Other - Last Name:HOGEBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP- PC
Mailing Address - Street 1:PO BOX 933421
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-3000
Mailing Address - Fax:
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-2706
Practice Address - Fax:513-636-2988
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20188105363LP0200X
OHAPRN.CNP.023804363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2565399Medicaid
OH0462231Medicaid