Provider Demographics
NPI:1336150499
Name:FRIEDMAN, JEAN (CNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:FRIEDMAN
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 1:25350 ROCKSIDE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-7110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25350 ROCKSIDE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-7110
Practice Address - Country:US
Practice Address - Phone:440-232-8381
Practice Address - Fax:440-374-4967
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04130NP363LW0102X
OHRN094433163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2165419Medicaid
OHNP12795Medicare PIN