Basic Information
| Provider Information | |||||||||
| NPI: | 1558818575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PISTONE | ||||||||
| FirstName: | JENNIFER-LEE | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HALAMEK | ||||||||
| OtherFirstName: | JENNIFER-LEE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 141 WAITE FARMS LN | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442121369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165380392 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7007 POWERS BLVD | ||||||||
| Address2: | |||||||||
| City: | PARMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441295437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407433000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2016 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.019815 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.