Jacqueline Anne Moheisen, RRT

Primary specialty

Registered Respiratory TherapistTaxonomy code 227900000X

License

1473 Issued in OH

Practice address

29728 Phillips Ave
Wickliffe, OH 44092-2212

Phone

(440) 585-2907

NPI assigned

Jul 17, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Miss Jacqueline Anne Polly Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374019200000",
    "number": "1184065211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29728 PHILLIPS AVE",
            "city": "WICKLIFFE",
            "state": "OH",
            "postal_code": "440922212",
            "telephone_number": "440-585-2907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29728 PHILLIPS AVE",
            "city": "WICKLIFFE",
            "state": "OH",
            "postal_code": "440922212",
            "telephone_number": "440-585-2907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHEISEN",
        "first_name": "JACQUELINE",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "RRT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-17",
        "last_updated": "2013-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "227900000X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Registered",
            "state": "OH",
            "license": "1473",
            "primary": true
        },
        {
            "code": "2279C0205X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Registered, Critical Care",
            "state": "OH",
            "license": "1473",
            "primary": false
        },
        {
            "code": "2279G1100X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Registered, General Care",
            "state": "OH",
            "license": "1473",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "POLLY",
            "middle_name": "ANNE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Meadow Falls Wickliffe Opco LLC
• Sheri Monique Mennefee, RN
• Ilana Mensch
• Michael Polsinelli
• Dana Marie Miller
• Tashay Morris
• Timothy Edward Moses
• George Muenster, D.O.
• Lydia Nahvala
• NE Ohio Health & Home Solutions

• Registered Respiratory Therapist in Wickliffe, OH
• Providers in Wickliffe, OH by specialty
• Registered Respiratory Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.