Provider Demographics
NPI:1730573965
Name:CHAGIN, JENNALEE (NP)
Entity type:Individual
Prefix:
First Name:JENNALEE
Middle Name:
Last Name:CHAGIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 WOOSTER RD
Mailing Address - Street 2:309
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-4174
Mailing Address - Country:US
Mailing Address - Phone:330-207-4121
Mailing Address - Fax:
Practice Address - Street 1:33 NORTH AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1925
Practice Address - Country:US
Practice Address - Phone:330-344-3990
Practice Address - Fax:330-634-9433
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16982NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH0091231OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP # - URGENT CARES
OH1992138028OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI # - URGENT CARES
OH1164814414OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI # - HWE
OH0125272Medicaid
OH1992138028OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI # - URGENT CARES