Individual
KALANA LATRIECE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
8809 BECKMAN AVE, CLEVELAND, OH 44104-2338
(216) 240-7833
Mailing address
8809 BECKMAN AVE, CLEVELAND, OH 44104-2338
(216) 240-7833
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
401253070611
OH
Other
Enumeration date
07/10/2012
Last updated
07/10/2012
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