Provider Demographics
NPI:1184065211
Name:MOHEISEN, JACQUELINE ANNE (RRT)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANNE
Last Name:MOHEISEN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:ANNE
Other - Last Name:POLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29728 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2212
Mailing Address - Country:US
Mailing Address - Phone:440-585-2907
Mailing Address - Fax:
Practice Address - Street 1:29728 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2212
Practice Address - Country:US
Practice Address - Phone:440-585-2907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1473227900000X, 2279C0205X, 2279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care
No2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care