Individual
CHACITY BIANCA GILLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
18605 KEWANEE AVE, CLEVELAND, OH 44119-2736
(216) 799-6974
Mailing address
18605 KEWANEE UP, CLEVELAND, OH 44119
(216) 799-6974
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN126236
OH
Other
Enumeration date
11/19/2009
Last updated
11/19/2009
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