Provider Demographics
NPI:1457063778
Name:GARVER, JESSICA ANN
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:GARVER
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 1:48669 BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9434
Mailing Address - Country:US
Mailing Address - Phone:330-843-3000
Mailing Address - Fax:
Practice Address - Street 1:15655 STATE ROUTE 170 STE A
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9672
Practice Address - Country:US
Practice Address - Phone:330-386-4303
Practice Address - Fax:216-229-2630
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH112080164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse