Provider Demographics
NPI:1770881716
Name:VUE, JERRY
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:VUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 N MAIN ST
Mailing Address - Street 2:#3
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-3044
Mailing Address - Country:US
Mailing Address - Phone:330-252-5665
Mailing Address - Fax:330-252-8173
Practice Address - Street 1:789 N MAIN ST
Practice Address - Street 2:#3
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3044
Practice Address - Country:US
Practice Address - Phone:330-252-5665
Practice Address - Fax:330-252-8173
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1997143374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide