Provider Demographics
NPI:1902000862
Name:HUGHLEY, JEANNIE LULA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:LULA
Last Name:HUGHLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 CALEDONIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2322
Mailing Address - Country:US
Mailing Address - Phone:216-374-2185
Mailing Address - Fax:
Practice Address - Street 1:990 CALEDONIA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44112-2322
Practice Address - Country:US
Practice Address - Phone:216-374-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN332113163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse