Provider Demographics
NPI:1265693642
Name:HALL, JENNIFER M (CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HALL
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 1:16801 CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4618
Mailing Address - Country:US
Mailing Address - Phone:440-543-7475
Mailing Address - Fax:440-708-1162
Practice Address - Street 1:16801 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4618
Practice Address - Country:US
Practice Address - Phone:440-543-7475
Practice Address - Fax:440-708-1162
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN227358363L00000X
OH03742-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2830986Medicaid
OHNP82191Medicare PIN