Individual
MS. IKEIA DOMMUNIQUE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2817 CENTRAL AVE APT 600, CLEVELAND, OH 44115-3139
(216) 469-9900
Mailing address
2817 CENTRAL AVE APT 600, CLEVELAND, OH 44115-3139
(216) 469-9900
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TR270708
DRIVER LICENSE
OH
Enumeration date
09/06/2019
Last updated
09/06/2019
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