Provider Demographics
NPI:1326841974
Name:LANTZER, JADA MARIE
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:MARIE
Last Name:LANTZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 TENNYSON AVE NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2620
Mailing Address - Country:US
Mailing Address - Phone:330-949-9834
Mailing Address - Fax:
Practice Address - Street 1:1906 TENNYSON AVE NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2620
Practice Address - Country:US
Practice Address - Phone:330-949-9834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant