Individual
EBONY NICOLE MOULTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
3363 E 123RD ST, APT. DOWN, CLEVELAND, OH 44120-3851
(216) 659-9638
Mailing address
3363 E 123RD ST, APT. DOWN, CLEVELAND, OH 44120-3851
(216) 659-9638
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
401399400612
OH
Other
Enumeration date
10/21/2012
Last updated
10/21/2012
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