Provider Demographics
NPI:1306633672
Name:CARRILLO, JESSENIA (RN)
Entity type:Individual
Prefix:
First Name:JESSENIA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4377 W 61ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-2846
Mailing Address - Country:US
Mailing Address - Phone:216-924-7108
Mailing Address - Fax:
Practice Address - Street 1:4377 W 61ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-2846
Practice Address - Country:US
Practice Address - Phone:216-924-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.514080163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn