Provider Demographics
NPI:1548549843
Name:SOREMEKUN, JADESOLA (RN)
Entity type:Individual
Prefix:
First Name:JADESOLA
Middle Name:
Last Name:SOREMEKUN
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 1:24113 E SILSBY RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1277
Mailing Address - Country:US
Mailing Address - Phone:216-622-5322
Mailing Address - Fax:
Practice Address - Street 1:893 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2003
Practice Address - Country:US
Practice Address - Phone:216-262-2246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH128591-IV164W00000X
OHRN388229163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse