Provider Demographics
NPI:1487840120
Name:ROOT, JANE M (MSN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:ROOT
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 JAVIT COURT
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3117
Mailing Address - Country:US
Mailing Address - Phone:330-797-9405
Mailing Address - Fax:330-953-1758
Practice Address - Street 1:104 JAVIT COURT
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3117
Practice Address - Country:US
Practice Address - Phone:330-797-9405
Practice Address - Fax:330-953-1758
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN12943364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health