Provider Demographics
NPI:1912247479
Name:MADASZ, JENNIFER (APRN- CNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MADASZ
Suffix:
Gender:F
Credentials:APRN- CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8146 TIMOTHY LN
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1079
Mailing Address - Country:US
Mailing Address - Phone:567-408-1496
Mailing Address - Fax:567-600-5698
Practice Address - Street 1:8146 TIMOTHY LN
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1079
Practice Address - Country:US
Practice Address - Phone:567-408-1496
Practice Address - Fax:567-600-5698
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP14294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH198720OtherMEDICARE PIN
OH0084478Medicaid