Basic Information
| Provider Information | |||||||||
| NPI: | 1265944219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEARS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2510 COMMONS BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454313821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374900123 | ||||||||
| FaxNumber: | 9373061536 | ||||||||
| Practice Location | |||||||||
| Address1: | 8290 OLD TROY PIKE STE 40A | ||||||||
| Address2: | |||||||||
| City: | HUBER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372084100 | ||||||||
| FaxNumber: | 9372084107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2017 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.021762 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.