Provider Demographics
NPI:1699489393
Name:JEWELL, JUDITH
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:JEWELL
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 1:2851 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:OH
Mailing Address - Zip Code:44437-1404
Mailing Address - Country:US
Mailing Address - Phone:330-978-1236
Mailing Address - Fax:
Practice Address - Street 1:2851 WARREN AVE
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:OH
Practice Address - Zip Code:44437-1404
Practice Address - Country:US
Practice Address - Phone:330-978-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide