Provider Demographics
NPI:1205497898
Name:JOSEPH, JENNIFER (APRNCNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:APRNCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-2802
Mailing Address - Country:US
Mailing Address - Phone:330-853-6477
Mailing Address - Fax:
Practice Address - Street 1:236 W 6TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2802
Practice Address - Country:US
Practice Address - Phone:330-932-1823
Practice Address - Fax:330-932-1832
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026045363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.026045OtherBOARD OF NURSING
OH0383391Medicaid