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Individual

EBONY SHERIE MCCULLOUGH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3224 KALAHARI ST NE, CANTON, OH 44705-3606
(234) 410-2074
Mailing address
3224 KALAHARI ST NE, CANTON, OH 44705-3606
(234) 410-2074

Taxonomy

Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
12345
OH
01
2345
ENGLISH
01
ENGLISH
ENGLISH
Enumeration date
01/14/2021
Last updated
01/14/2021
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