Individual
MISS SHAKEILA DEVAUGHN MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
715 BELVEDERE AVE SE, WARREN, OH 44484-4325
(330) 766-1887
Mailing address
715 BELVEDERE AVE SE, WARREN, OH 44484-4325
(330) 766-1887
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
401637600414
OH
Other
Enumeration date
07/02/2018
Last updated
07/02/2018
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