Provider Demographics
NPI:1912228354
Name:FASCIONE, JEANNA MARIE (DPM)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:MARIE
Last Name:FASCIONE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 RIFFEL RD STE A
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8592
Mailing Address - Country:US
Mailing Address - Phone:330-345-5500
Mailing Address - Fax:330-345-7793
Practice Address - Street 1:365 RIFFEL RD STE A
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-8592
Practice Address - Country:US
Practice Address - Phone:330-345-5500
Practice Address - Fax:330-345-7793
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135000706213E00000X, 390200000X
OH36.003645213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program