Individual
DANIELLE PROSTAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
1010 E 346TH ST, EASTLAKE, OH 44095-2629
(440) 853-9437
Mailing address
1010 E 346TH ST, EASTLAKE, OH 44095-2629
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
401460691112
OH
374U00000X
Home Health Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
401460691112
—
OH
Enumeration date
09/26/2017
Last updated
09/26/2017
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