Jacqueline S Shriver
Nurse Practitioner - Women's Health
1140 S Knoxville Ave Ste B
Saint Marys
, Ohio 45885-2609
Jacqueline S Shriver
Nurse Practitioner - Women's Health
1140 S Knoxville Ave Ste B
Saint Marys
, Ohio 45885-2609
(419) 394-9575
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About
Features
Specialties
- Nurse Practitioner - Women's Health
Languages spoken
- English
Location
First Address
- Jacqueline S Shriver
- 200 Saint Clair Ave
- Saint Marys, OH
- Zip : 45885-2400
- Fax : (419) 394-9575
- Phone : (419) 300-1129
Second Address
- Jacqueline S Shriver
- 1140 S Knoxville Ave Ste B
- Saint Marys, OH
- Zip : 45885-2609
- Fax : (419) 394-7313
- Phone : (419) 394-7314
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Is Jacqueline S Shriver a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LW0102X | Nurse Practitioner - Women's Health | NP2122 | OH |
National Provider Identifier
| NPI | 1083606610 |
|---|---|
| Provider Name | Jacqueline S Shriver |
| First Address | Saint Marys, OH 45885-2400 |
| Second Address | Saint Marys, OH 45885-2609 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 19/08/2005 |
| Last Update Date | 19/04/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0105065 | MEDICAID GROUP (01) | OH |
| 0742307 | (05) | OH |
| 1184652539 | GROUP NPI (01) | OH |
| 34-1689161 | GROUP TAX ID (01) | OH |
| 9934723 | GROUP MEDICARE (01) | OH |
| H561340 | MEDICARE PTAN (01) | OH |
| P03121 | (02) | OH |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.