Individual
MRS. JENNIFER MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
9500 EUCLID AVE, J 2 2, CLEVELAND, OH 44195-0001
(216) 444-6483
(216) 636-2700
Mailing address
9500 EUCLID AVE, J 2-2, CLEVELAND, OH 44195-0001
(216) 444-6483
(216) 445-3573
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
NP07699
OH
363LA2200X
Adult Health Nurse Practitioner
Primary
NP07699
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000344039
ANTHEM BLUE CROSS/BLUE SH
OH
01
—
1001149
QUALCHOICE
OH
01
—
107132
KAISER
OH
05
—
2507684
—
OH
01
—
341487428
TAX ID
OH
01
—
7441606
AETNA
OH
01
—
A60194
SUMMACARE
OH
01
—
P00191907
RAILROAD MEDICARE
OH
Enumeration date
07/07/2006
Last updated
02/24/2011
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