Individual
KIMYATTA E FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
3974 E 121ST ST, CLEVELAND, OH 44105-4551
(216) 609-6411
Mailing address
3974 E 121ST ST, CLEVELAND, OH 44105-4551
(216) 609-6411
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
0303392
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0303392
—
OH
Enumeration date
02/11/2021
Last updated
02/11/2021
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