Individual
JONTAE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 E 177TH ST UNIT 1, CLEVELAND, OH 44119-3143
(216) 450-7939
Mailing address
1115 E 177TH ST UNIT 1, CLEVELAND, OH 44119-3143
(216) 450-7939
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
401790980915
OH
Other
Enumeration date
02/16/2023
Last updated
06/14/2023
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