Provider Demographics
NPI:1861095036
Name:LIASON, JEWELETT KHRISTEN
Entity type:Individual
Prefix:
First Name:JEWELETT
Middle Name:KHRISTEN
Last Name:LIASON
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 1:251 COITSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-1104
Mailing Address - Country:US
Mailing Address - Phone:330-812-1941
Mailing Address - Fax:
Practice Address - Street 1:251 COITSVILLE RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:OH
Practice Address - Zip Code:44405-1104
Practice Address - Country:US
Practice Address - Phone:330-812-1941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSD413598Medicaid