JACQUELINE ANN SUPPAN (NPI# 1124084777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124084777 |
| Entity Type | Individual |
| Full Name | JACQUELINE ANN SUPPAN |
| Credential | MSN, CNS |
| Practice Address |
733 Market Ave S Canton OH 44702-2165 |
| Mailing Address |
2825 E Paradise Street Ext Orrville OH 44667-9621 |
| Practice Telephone | 3304894600 |
| Practice Fax Number | 2162292642 |
| Mailing Telephone | 3306832408 |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2020-04-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SA2200X |
Clinical Nurse Specialist Specialization: Adult Health |
CTP-06570 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
733 MARKET AVE S |
| City | CANTON |
| State | OH |
| Zip Code | 44702-2165 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700411287 | Lindsea Noel Moore | Dietitian, Registered | 733 Market Ave S, Canton, OH 44702-2165 | 2020-03-05 |
| 1396280376 | Jeffrey William Powers | Nurse Practitioner | 733 Market Ave S, Canton, OH 44702 | 2016-12-29 |
| 1255880282 | Kristen Leigh Snyder | Social Worker | 733 Market Ave S, Canton, OH 44702-2165 | 2016-10-03 |
| 1023464682 | John Peterson | Counselor | 733 Market Ave S, Canton, OH 44702-2165 | 2016-05-12 |
| 1104206945 | Andrea Crayden | Social Worker | 733 Market Ave S, Canton, OH 44702-2165 | 2015-06-07 |
| 1063825537 | Christina Carpenter | Nurse Practitioner | 733 Market Ave S, Canton, OH 44702-2165 | 2014-06-03 |
| 1326470493 | Scott Michael Lautensleger | Social Worker | 733 Market Ave S, Canton, OH 44702-2165 | 2013-07-31 |
| 1700228269 | Kenneth N Wycoff | Nurse Practitioner | 733 Market Ave S, Canton, OH 44702-2165 | 2013-07-25 |
| 1710275680 | Sandra Kaye Shaw | Nurse Practitioner | 733 Market Ave S, Canton, OH 44702-2165 | 2011-07-13 |
| 1437478484 | Jennifer S Mayle | Dietitian, Registered | 733 Market Ave S, Canton, OH 44702-2165 | 2010-05-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588138390 | Angela Rhoad | Peer Specialist | Coleman Professional Services 400 Tuscarawas St W., Canton, OH 44702 | 2019-01-15 |
| 1710426291 | Aaron Valentine | Community Health Worker | 401 West Tuscarawas Street, Suite 501, Canton, OH 44702 | 2017-02-17 |
| 1386028389 | Leigh Fotheringham | Skilled Nursing Facility | 800 Market Ave. North, Canton, OH 44702 | 2015-07-20 |
| 1427485127 | Canton College Preparatory School | Local Education Agency (LEA) | 101 Cleveland Avenue Nw, Canton, OH 44702 | 2013-09-26 |
| 1730337197 | Linda Lee Gemma | Registered Nurse | 733 Market St South, Canton, OH 44702 | 2008-08-28 |
| 1447372875 | Rushina Anil Patel | Physical Therapist | 800 Market Ave N, Canton, OH 44702 | 2007-04-05 |
| 1124183702 | John Mannos | Family Medicine | 333 2nd St Se, Canton, OH 44702 | 2006-12-26 |
| 1629556949 | Judy Chava | Nurse Practitioner | 400 Tuscarawas St W, Canton, OH 44702 | 2018-07-30 |
| 1407359656 | Reginald A Corner | Case Manager/Care Coordinator | 401 Tuscarawas St W Ste 501, Canton, OH 44702 | 2018-03-14 |
| 1609378322 | Nicole Osborne | Peer Specialist | 624 Market Ave N, Canton, OH 44702 | 2018-03-08 |
| Find all providers in zip 44702 | ||||
| Taxonomy Code | 364SA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649605080 | Kathleen Flaherty | Clinical Nurse Specialist | 2600 Cleveland Ave Nw, Rh 201g, Canton, OH 44709-3308 | 2013-09-04 |
| 1700157799 | Leeanne Stuhlmiller | Clinical Nurse Specialist | 2600 6th St Sw, Suitea2-710, Canton, OH 44710-1702 | 2012-01-23 |
| 1497987283 | Mary Frances Paris | Clinical Nurse Specialist | 2600 Sixth Street Sw, Canton, OH 44710 | 2009-08-13 |
| 1457590804 | Vickey Chrisman | Clinical Nurse Specialist | 4580 Stephens Cir Nw Ste 202, Canton, OH 44718 | 2009-02-09 |
| 1104077460 | Patricia Anne Campos | Clinical Nurse Specialist | 2600 6th St Sw, Canton, OH 44710-1702 | 2008-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184243941 | Christina Canfield | Clinical Nurse Specialist | 9500 Euclid Ave # J6, Cleveland, OH 44195-0001 | 2020-04-13 |
| 1073040929 | Stacy L Burns | Clinical Nurse Specialist | 250 S Osborn Ave, Youngstown, OH 44509-2909 | 2017-05-22 |
| 1134655350 | Bindhu Sajay | Clinical Nurse Specialist | 45431 Isaac Dr, Beavercreek, OH 45431-3051 | 2017-05-08 |
| 1750828406 | Keith B Evans | Clinical Nurse Specialist | 12 Lincoln Dr, Shelby, OH 44875-1482 | 2017-01-19 |
| 1760839070 | Deanna Petsas | Clinical Nurse Specialist | 35157 Poplar St, North Ridgeville, OH 44039-1549 | 2016-05-17 |
| 1083087852 | Tracy A. Riley | Clinical Nurse Specialist | 2270 Mohler Dr Nw, North Canton, OH 44720-5736 | 2015-11-03 |
| 1639542574 | Althea Premraj | Clinical Nurse Specialist | 26 Keswick Dr, Hudson, OH 44236-3338 | 2015-10-31 |
| 1013392646 | Lydia Booher | Clinical Nurse Specialist | 2320 12th St Sw, Akron, OH 44314-2058 | 2015-07-24 |
| 1265813984 | Ronald Rock | Clinical Nurse Specialist | 9500 Euclid Ave # M2-105, Cleveland, OH 44195-0001 | 2015-06-18 |
| 1518387257 | Beth Canfield | Clinical Nurse Specialist | 6721 Idlelawn Ave Nw, Canal Fulton, OH 44614-9420 | 2014-04-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.