Provider Demographics
NPI:1104456268
Name:MAINA, JANE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MAINA
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 1:1765 E 232ND ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2018
Mailing Address - Country:US
Mailing Address - Phone:216-688-7173
Mailing Address - Fax:216-938-7436
Practice Address - Street 1:1765 E 232ND ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2018
Practice Address - Country:US
Practice Address - Phone:216-688-7173
Practice Address - Fax:216-938-7436
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSQ609632172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver