Provider Demographics
NPI:1508696196
Name:SIUREK, JODI L
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:SIUREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SOUTHBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4312
Mailing Address - Country:US
Mailing Address - Phone:216-409-3229
Mailing Address - Fax:
Practice Address - Street 1:700 SOUTHBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4312
Practice Address - Country:US
Practice Address - Phone:216-409-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No253Z00000XAgenciesIn Home Supportive Care