| Doctor Name: | JACKIE CERVANTES |
| NPI Number: | 1629197009 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 2627456 |
| Business Practice Address: | 308 Jack Roush Way Manchester, OH - 451441423 |
| Business Phone Number: | 9375498502 |
| Business Fax Number: | |
| Mailing Address: | 308 Jack Roush Way, MANCHESTER |
| State: | OH |
| Postal Code: | 451441423 |
| Phone Number: | 9375498502 |
| Fax Number: | |
| NPI Enumeration Date: | 03/28/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 374U00000X |
| License Number: | 2627456 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Home Health Aide |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person trained to assist public health nurses, home health nurses, and other health professionals in the bedside care of patients in their homes. |