Individual
TAWANDA JOLLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
INDEPENDANT PROVIDER
Contact information
Practice address
4126 E 110TH ST, CLEVELAND, OH 44105-5325
(216) 203-6053
Mailing address
4126 E 110TH ST, CLEVELAND, OH 44105-5325
(216) 203-6053
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
0295563
OH
Other
Enumeration date
11/16/2020
Last updated
11/16/2020
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