Individual
JENNIFER M SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9500 MENTOR AVE, SUITE 100, MENTOR, OH 44060-8713
(440) 352-4880
(440) 352-3629
Mailing address
9500 EUCLID AVE, CLEVELAND, OH 44195-0001
(440) 445-4500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2541
OH
Other
Enumeration date
06/14/2007
Last updated
04/08/2021
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