Provider Demographics
NPI:1801294558
Name:ANDERSON, JEFFREY PAUL (RN)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:PAUL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 S GREGG RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1306
Mailing Address - Country:US
Mailing Address - Phone:330-329-6024
Mailing Address - Fax:
Practice Address - Street 1:1992 S GREGG RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1306
Practice Address - Country:US
Practice Address - Phone:330-329-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN290140163W00000X, 163WC0400X, 163WE0003X, 163WG0000X, 163WH0200X, 163WI0500X, 163WM0705X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WW0000XNursing Service ProvidersRegistered NurseWound Care