Individual
MRS. JENNIVIERE HOMITZ-DANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
8701 MENTOR AVE, MENTOR, OH 44060-6103
(440) 266-0770
(440) 266-0257
Mailing address
8701 MENTOR AVE, MENTOR, OH 44060-6103
(440) 266-0770
(440) 266-0257
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
393799
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
366768
—
OH
Enumeration date
08/24/2016
Last updated
10/16/2019
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