Provider Demographics
NPI:1538949144
Name:CONNOR, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CONNOR
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 1:3101 BOETTLER ST NE
Mailing Address - Street 2:
Mailing Address - City:N CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2362
Mailing Address - Country:US
Mailing Address - Phone:154-045-5473
Mailing Address - Fax:
Practice Address - Street 1:3101 BOETTLER ST NE
Practice Address - Street 2:
Practice Address - City:N CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-2362
Practice Address - Country:US
Practice Address - Phone:154-045-5473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant