Organization
ADMIRAL MEDICAL MANAGEMENT GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KETURA JACKSON APRN CNP (APRN CNP)
(216) 855-7775
Entity
Organization
Contact information
Practice address
11201 SHAKER BLVD UNIT 201, CLEVELAND, OH 44104-3869
(216) 855-7775
Mailing address
11201 SHAKER BLVD UNIT 201, CLEVELAND, OH 44104-3869
(216) 855-7775
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
366986
OH
261Q00000X
Clinic/Center
—
OH
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
OH
261QP2300X
Primary Care Clinic/Center
—
OH
Other
Enumeration date
02/22/2018
Last updated
09/17/2024
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