Provider Demographics
NPI:1952488793
Name:HAUSER, JILL (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:
Last Name:HAUSER
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 1:1411 W 110TH ST
Mailing Address - Street 2:UP
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1411 W 110TH ST
Practice Address - Street 2:UP
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2403
Practice Address - Country:US
Practice Address - Phone:216-221-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN085178164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2157482Medicare UPIN