Individual
KADETRA LASHUNN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
6815 HOUGH AVE, CLEVELAND, OH 44103-3943
(501) 542-2028
Mailing address
6815 HOUGH AVE, CLEVELAND, OH 44103-3943
(501) 542-2020
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
320434040423
OH
Other
Enumeration date
10/13/2023
Last updated
10/13/2023
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