Provider Demographics
NPI:1245272582
Name:VEVERKA, JILL A (CNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:VEVERKA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 WHITE POND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4208
Mailing Address - Country:US
Mailing Address - Phone:330-869-0954
Mailing Address - Fax:330-869-0964
Practice Address - Street 1:570 WHITE POND DR STE 200
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4208
Practice Address - Country:US
Practice Address - Phone:330-869-0954
Practice Address - Fax:330-869-0964
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07095363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ66437Medicare UPIN
NP20501Medicare ID - Type Unspecified