Basic Information
| Provider Information | |||||||||
| NPI: | 1336584994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JELISH | ||||||||
| FirstName: | MRUDULA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SUMMIT ST FL 7 | ||||||||
| Address2: | HEARTLAND CARE PARTNERS | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436042615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192526018 | ||||||||
| FaxNumber: | 8005645952 | ||||||||
| Practice Location | |||||||||
| Address1: | 5651 LIMESTONE RD | ||||||||
| Address2: | HEARTLAND CARE PARTNERS | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198081217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192526018 | ||||||||
| FaxNumber: | 8005645952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2013 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | LG-0000672 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.