Individual
EBONI DANYALE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3143 EAST 99TH, CLEVELAND, OH 44104
(216) 269-8117
Mailing address
3143 E 99TH ST, CLEVELAND, OH 44104-5322
(216) 269-8117
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
153123
OH
Other
Enumeration date
10/24/2014
Last updated
10/24/2014
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