Provider Demographics
NPI:1205144193
Name:WESSEL, JILLIAN R (AA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:R
Last Name:WESSEL
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:R
Other - Last Name:BEECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4665 DOUGLAS CIR NW STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3673
Mailing Address - Country:US
Mailing Address - Phone:440-816-6246
Mailing Address - Fax:440-816-6263
Practice Address - Street 1:18697 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3417
Practice Address - Country:US
Practice Address - Phone:440-816-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000172367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant